Bonney Lake Optical, Inc

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BONNEY LAKE OPTICAL, INC

Doing business as

Spanaway Lake Optical

Practice address

9801 204TH Ave E
Bonney Lake, WA 98391-6559

Phone

(253) 750-8135

NPI assigned

Jan 4, 2007

Last updated

Jan 31, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sean CudahyNPI 1841641719

Title

Cfo

Phone

(253) 750-8135

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Spanaway Lake Optical Doing business as

Tax ID family

Bonney Lake Optical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bonney Lake Optical, Inc

  dba Emerald Eye Care

  • Pediatric Optometrist
  • Bonney Lake, WA
  • NPI 1154478014
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sean Cudahy, O.D.

  • Pediatric Optometrist
  • Bonney Lake, WA
  • NPI 1841641719
  NPD Authorized official
• Kyleigh Johnson, OD

  • Optometrist
  • Issaquah, WA
  • NPI 1891447363
  NPD (past)

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675123200000",
    "number": "1902953581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9801 204TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916559",
            "telephone_number": "253-750-8135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9801 204TH AVE E",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983916559",
            "telephone_number": "253-750-8135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEY LAKE OPTICAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A",
        "authorized_official_last_name": "CUDAHY",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "253-750-8135"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "1640",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2001360",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spanaway Lake Optical",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spanaway Lake Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bonney Lake Dental Center
• Bonney Lake Dental LLC (Comfort Dental Bonney Lake)
• Bonney Lake Family Dentistry, PLLC (Bonney Lake Family Dentistry)
• Bonney Lake Medical Center
• Bonney Lake Optical, Inc (Emerald Eye Care)
• Bonney Lake Oral Surgery
• Bonney Lake Pharmacy, LLC (Bonney Lake Pharmacy)
• Bonney Lake Physical Therapy and Hand Rehab, PLLC
• Billy Boraphet
• Kathleen G Borgstrom, LMP

• Optometrist in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2023; 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.