Active NPI
Mary Ellen Quan, O.D.
- Optometrist
- Issaquah, WA
National Provider Identifier
1750525820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 60096396
- Practice address
- 2519 NE Kensington CT
Issaquah, WA 98029-3658 - Phone
- (901) 277-8349
- NPI assigned
- Apr 20, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 60096396 | WA | Primary |
| Optometrist | 152W00000X | 707 | HI |
Addresses
Primary practice location
2519 NE Kensington CT
Issaquah, WA 98029-3658
Mailing address
2519 NE Kensington CT
Issaquah, WA 98029-3658
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 707 | HI | MD | Optometrist |
| 60096396 | WA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240185600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1253059200000",
"number": "1750525820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2519 NE KENSINGTON CT",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980293658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2519 NE KENSINGTON CT",
"city": "ISSAQUAH",
"state": "WA",
"postal_code": "980293658",
"telephone_number": "901-277-8349"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUAN",
"first_name": "MARY ELLEN",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-04-20",
"last_updated": "2009-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "60096396",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "HI",
"license": "707",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Issaquah, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.