Evergreen Optometry LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60369639 Issued in WA

Legal business name

EVERGREEN OPTOMETRY LLC

Practice address

2811 W 10TH Ave
Suite C
Kennewick, WA 99336-3104

Phone

(509) 734-2511

Fax

(509) 734-1632

NPI assigned

Jul 15, 2015

Organization subpart

No

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

Authorized official

Name

Christine Chong, OD

Title

Provider

Phone

(509) 734-2511

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1436918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453680000000",
    "number": "1861876203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2811 W 10TH AVE",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993363104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 W 10TH AVE",
            "address_2": "SUITE C",
            "city": "KENNEWICK",
            "state": "WA",
            "postal_code": "993363104",
            "telephone_number": "509-734-2511",
            "fax_number": "509-734-1632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN OPTOMETRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-15",
        "last_updated": "2016-01-25",
        "status": "A",
        "authorized_official_last_name": "CHONG",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "509-734-2511",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60369639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.