NPIMap

Organization Active NPI

Justin Burgerson Eyecare Services LLC

  • Optometrist
  • Spokane Valley, WA
National Provider Identifier
1891384616
Registry record updated Sep 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
JUSTIN BURGERSON EYECARE SERVICES LLC
Practice address
20 N Evergreen Rd Ste 102
Spokane Valley, WA 99216-5083
Phone
(509) 924-5665
Fax
(509) 922-9812
NPI assigned
Jan 15, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2023

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

Authorized official

Name
Justin L Burgerson, ODNPI 1447706957
Title
President
Phone
(509) 220-6353

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

20 N Evergreen Rd Ste 102
Spokane Valley, WA 99216-5083

Mailing address

20 N Evergreen Rd Ste 102
Spokane Valley, WA 99216-5083
Phone (509) 924-5665

Other names 1

  • Valley Vision Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Info@valleyvisionspokane.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210128000590 WA Part B Supplier - Clinic/Group Practice 2961816277 Receives reassigned benefits from 2 practitioners
Practice locations: Spokane Valley, WA

National Provider Directory

National Provider Directory

Locations

20 N Evergreen Rd
#102
Spokane Valley, WA 99216
Phone (509) 924-5665

Interoperability endpoints

  • Direct secure messaging: info@valleyvisionspokane.com

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1610668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693958400000",
    "number": "1891384616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 N EVERGREEN RD STE 102",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992165083",
            "telephone_number": "509-924-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 N EVERGREEN RD STE 102",
            "city": "SPOKANE VALLEY",
            "state": "WA",
            "postal_code": "992165083",
            "telephone_number": "509-924-5665",
            "fax_number": "509-922-9812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JUSTIN BURGERSON EYECARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-15",
        "last_updated": "2023-09-06",
        "certification_date": "2022-08-09",
        "status": "A",
        "authorized_official_last_name": "BURGERSON",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "509-220-6353",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Info@valleyvisionspokane.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "20 N Evergreen Rd Ste 102",
            "city": "Spokane Valley",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992165083",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Valley Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spokane Valley, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2023; 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.