Active NPI
Mark R Gildenhar, MD
- Ophthalmology Physician
- Puyallup, WA
National Provider Identifier
1790796860
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD00017654
- Practice address
- 1703 S Meridian
Suite 101
Puyallup, WA 98371 - Phone
- (253) 848-3000
- Fax
- (253) 840-6514
- NPI assigned
- Aug 11, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD00017654 | WA | Primary |
Addresses
Primary practice location
1703 S Meridian
Suite 101
Puyallup, WA 98371
Mailing address
1703 S Meridian
Suite 101
Puyallup, WA 98371
Phone (253) 848-3000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8175408 | Medicaid | WA |
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00017654 | WA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337299200000",
"number": "1790796860",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1703 S MERIDIAN",
"address_2": "SUITE 101",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "98371",
"telephone_number": "253-848-3000",
"fax_number": "253-840-6514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1703 S MERIDIAN",
"address_2": "SUITE 101",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "98371",
"telephone_number": "253-848-3000",
"fax_number": "253-840-6514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILDENHAR",
"first_name": "MARK",
"middle_name": "R",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2012-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WA",
"license": "MD00017654",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8175408",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.