Evergreen Eye Center, PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

Legal business name

EVERGREEN EYE CENTER, PLLC

Practice address

2820 Griffin Ave Ste 101
Enumclaw, WA 98022-2373

Phone

(360) 802-4549

Fax

(360) 825-8354

NPI assigned

Nov 7, 2006

Organization subpart

No

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 2

Addresses

Other identifiers 5

Other names 1

• Evergreen Eye Center Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Other NPIs on the same Medicare enrollment 6

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

• Evergreen Eye Center, PLLC

  • Ophthalmology Physician
  • Seattle, WA
  • NPI 1275387995

  O20040304001193

  Same enrollment
• Evergreen Eye Center, PLLC

  • Ophthalmology Physician
  • Auburn, WA
  • NPI 1346319852

  O20040304001193

  Same enrollment
• Evergreen Eye Center, PLLC

  • Ophthalmology Physician
  • Tacoma, WA
  • NPI 1407401920

  O20040304001193

  Same enrollment
• Evergreen Eye Center, PLLC

  • Ophthalmology Physician
  • Burien, WA
  • NPI 1538238043

  O20040304001193

  Same enrollment
• Evergreen Eye Center, PLLC

  • Ophthalmology Physician
  • Federal Way, WA
  • NPI 1700959293

  O20040304001193

  Same enrollment
• Evergreen Eye Center, PLLC

  • Ophthalmology Physician
  • Seattle, WA
  • NPI 1831607522

  O20040304001193

  Same enrollment

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1881763373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34719 6TH AVE S",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038714",
            "telephone_number": "206-212-2100",
            "fax_number": "206-212-2174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 GRIFFIN AVE STE 101",
            "city": "ENUMCLAW",
            "state": "WA",
            "postal_code": "980222373",
            "telephone_number": "360-802-4549",
            "fax_number": "360-825-8354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN EYE CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-07",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "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": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICS ENUMCLAW EEC",
            "identifier": "891451",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NBN",
            "identifier": "WA0527",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0870427",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7080781",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KCM",
            "identifier": "EV8144",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Enumclaw SNF Operations, LLC
• Enumclaw Vision Clinic PLLC
• Jennifer Marie Erickson, PA-C
• Kelli Michelle Espinosa
• Katie Etherington, CNM, WHNP-BC
• Evergreen Washington Healthcare Enumclaw, L.L.C.
• Family Physical Therapy PLLC
• Fang Acupuncture Clinic
• Carrie Fang, L.A.
• Kelly Ferguson

• All providers in Enumclaw, WA
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.