NPIMap

Organization Active NPI

Eye Associates Northwest, PLLC

  • Ophthalmology Physician
  • Seattle, WA
National Provider Identifier
1811952815
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
EYE ASSOCIATES NORTHWEST, PLLC
Practice address
1101 Madison St Ste 600
Seattle, WA 98104-1340
Phone
(206) 215-2020
Fax
(206) 215-2022
NPI assigned
Apr 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rosa Angelica Campos
Title
Credentialing Manager
Phone
(206) 215-2004

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X Primary
Ambulatory Surgical Clinic/Center 261QA1903X
Durable Medical Equipment & Medical Supplies 332B00000X
Eyewear Supplier 332H00000X

Addresses

Primary practice location

1101 Madison St Ste 600
Seattle, WA 98104-1340

Mailing address

1101 Madison St
Suite 600
Seattle, WA 98104-1306
Phone (206) 215-2020

Other practice location 1

1455 NW Leary Way Ste 300
Seattle, WA 98107-5138
Phone (206) 784-3350

Other practice location 2

21616 76th Ave W Ste 110
Edmonds, WA 98026-7512
Phone (425) 775-0548

Other practice location 3

155 NE 100th St Ste 110
Seattle, WA 98125-8007
Phone (206) 363-8855

Other practice location 4

11325 NE 120th St
Kirkland, WA 98034-6907
Phone (425) 821-6655

Other practice location 5

11919 NE 128th St Ste A
Kirkland, WA 98034-7204
Phone (425) 821-6655

Other identifiers 1

IdentifierTypeStateIssuer
1019625MedicaidWA

Other names 1

  • Eye Associates Northwest Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040216001011 WA Part B Supplier - Clinic/Group Practice 2961397385 Receives reassigned benefits from 15 practitioners
Practice locations: Seattle, WA; Kirkland, WA; Edmonds, WA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2312078Eye Associates Northwest - Edmonds21616 76TH Ave W Ste 110, Edmonds, WA 98026Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Eye Associates Northwes2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

11919 NE 128th St
Ste A
Kirkland, WA 98034
Phone (425) 820-6307

11325 NE 120th St
Kirkland, WA 98034
Phone (425) 821-6655

1101 Madison St
Ste 580
Seattle, WA 98104
Phone (206) 400-7625

Ownership & related parties

Subparts reporting this organization as parent 5

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1811952815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST",
            "address_2": "SUITE 600",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041306",
            "telephone_number": "206-215-2020",
            "fax_number": "206-215-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 MADISON ST STE 600",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041340",
            "telephone_number": "206-215-2020",
            "fax_number": "206-215-2022"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1455 NW Leary Way Ste 300",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981075138",
            "country_code": "US",
            "telephone_number": "206-784-3350",
            "fax_number": "206-215-2022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "21616 76th Ave W Ste 110",
            "address_purpose": "LOCATION",
            "city": "Edmonds",
            "state": "WA",
            "postal_code": "980267512",
            "country_code": "US",
            "telephone_number": "425-775-0548",
            "fax_number": "206-215-2022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "155 NE 100th St Ste 110",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981258007",
            "country_code": "US",
            "telephone_number": "206-363-8855",
            "fax_number": "206-215-2022",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11325 NE 120th St",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980346907",
            "country_code": "US",
            "telephone_number": "425-821-6655",
            "fax_number": "425-821-8836",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11919 NE 128th St Ste A",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "980347204",
            "country_code": "US",
            "telephone_number": "425-821-6655",
            "fax_number": "206-215-2022",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EYE ASSOCIATES NORTHWEST, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-20",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A",
        "authorized_official_last_name": "CAMPOS",
        "authorized_official_first_name": "ROSA",
        "authorized_official_middle_name": "ANGELICA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "206-215-2004"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1019625",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eye Associates Northwest",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.