Individual provider Active NPI

Kirsten Ma

  • Optometrist
  • Federal Way, WA
National Provider Identifier
1891367140
Registry record updated Jul 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD61184043 Issued in WA
Practice address
1705 S 324TH PL
Federal Way, WA 98003-8504
Phone
(253) 661-6005
NPI assigned
Jul 15, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD61184043 WA Primary

Addresses

Primary practice location

1705 S 324TH PL
Federal Way, WA 98003-8504

Mailing address

1705 S 324TH PL
Federal Way, WA 98003-8504

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220915001495 WA Practitioner - Optometry 6204211055 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Issaquah Vision Center PLLCGroup PAC ID 3577822907, 2 clinicians
Renton Vision Clinic PLLCGroup PAC ID 9739404757, 2 clinicians

Practice addresses (Care Compare)

1460 NW Gilman Blvd
Suite K2
Issaquah, WA 98027-5300
Phone (425) 654-3652

3218 NE 12TH St
Suite a
Renton, WA 98056-3405
Phone (425) 228-3364

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OD61184043WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Issaquah Vision Center PLLC Optometrist CurrentSince Jul 11, 2024 Accepting new patients
Renton Vision Clinic PLLC Optometrist CurrentSince Jul 20, 2022 Accepting new patients

Locations

1460 NW Gilman Blvd
Ste K2
Issaquah, WA 98027
Phone (425) 654-3652

3218 NE 12th St
Ste A
Renton, WA 98056
Phone (425) 228-3364

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1626307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626307200000",
    "number": "1891367140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1705 S 324TH PL",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 S 324TH PL",
            "city": "FEDERAL WAY",
            "state": "WA",
            "postal_code": "980038504",
            "telephone_number": "253-661-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MA",
        "first_name": "KIRSTEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-15",
        "last_updated": "2021-07-15",
        "certification_date": "2021-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD61184043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Federal Way, WA

Sources for this page

Verify at the official NPI Registry.