NPIMap

Organization Active NPI

Tulalip Tribes of Washington

Doing business as Tulalip Tribe Eye Clinic

  • Optometrist
  • Tulalip, WA
National Provider Identifier
1831946797
Registry record updated Jul 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
TULALIP TRIBES OF WASHINGTON
Doing business as
Tulalip Tribe Eye Clinic
Practice address
7520 Totem Beach Rd
Tulalip, WA 98271-6160
Phone
(360) 716-4511
NPI assigned
Apr 30, 2024
Last updated
Jul 9, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
TULALIP TRIBES OF WASHINGTONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2024

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

Authorized official

Name
Emily Benham
Title
Eye Clinic Lead
Phone
(360) 716-5660

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary
Pediatric Optometrist 152WP0200X

Addresses

Primary practice location

7520 Totem Beach Rd
Tulalip, WA 98271-6160

Mailing address

6406 Marine Dr Ste a
Tulalip, WA 98271-9775

Other names 1

  • Tulalip Tribe Eye Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160615001117 TX Part B Supplier - Clinic/Group Practice 7719879782 Receives reassigned benefits from 49 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tulalip, WA

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Tulalip Health Clinic13 organizations share this tax ID, including this one
Part of
Tulalip Health Clinic

Other organizations with this tax ID 12

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

Locations

7627 41st Ave NW
Tulalip, WA 98271
Phone (360) 651-4511

6406 Marine Dr
Ste A
Tulalip, WA 98271

Practitioners & affiliated clinicians

Practitioners 49

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 49

NPI Registry JSON

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

{
    "created_epoch": "1714435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720483200000",
    "number": "1831946797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6406 MARINE DR STE A",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982719775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7520 TOTEM BEACH RD",
            "city": "TULALIP",
            "state": "WA",
            "postal_code": "982716160",
            "telephone_number": "360-716-4511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TULALIP TRIBES OF WASHINGTON",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TULALIP TRIBES OF WASHINGTON",
        "enumeration_date": "2024-04-30",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A",
        "authorized_official_last_name": "BENHAM",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "EYE CLINIC LEAD",
        "authorized_official_telephone_number": "360-716-5660"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tulalip Tribe Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tulalip, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.