Blue Wave Eye Doctors Professional Limited Liability Company

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY

Doing business as

VISIONWORKS DOCTORS OF OPTOMETRY

Practice address

921 N 10TH St Ste B
Renton, WA 98057-5591

Phone

(425) 255-1022

Fax

(425) 255-1176

NPI assigned

Aug 23, 2022

Organization subpart

No

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

Authorized official

Name

Dolsie McDonald

Title

Credentialing Manager

Phone

(726) 444-4078

Specialties & licenses 1

Addresses

Other names 1

• VISIONWORKS DOCTORS OF OPTOMETRY Doing business as

Locations

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661212800000",
    "number": "1881313047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HOUSTON ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052299",
            "telephone_number": "800-340-0129",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 N 10TH ST STE B",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980575591",
            "telephone_number": "425-255-1022",
            "fax_number": "425-255-1176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "DOLSIE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "726-444-4078"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "VISIONWORKS DOCTORS OF OPTOMETRY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Caritha Blair
• Wendy Blair, RD
• Leeann Marie Blattner, ARNP
• Aminta Ann Blinka, M.D.
• Terence A Block, MD
• Nicole Averil Blythe, MSW
• Christl Joy Board, LMP
• Aaron Justin Bobb, MD
• Clinton T Bocanegra, LAT, ATC
• Barry I. Bockow, M.D.

• Eyewear Supplier in Renton, WA
• Providers in Renton, WA by specialty
• Eyewear Supplier in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.