Corliss Optometrists

Primary specialty

OptometristTaxonomy code 152W00000X

License

600080747 Issued in WA

Legal business name

CORLISS OPTOMETRISTS

Practice address

312 4TH St SE
Puyallup, WA 98372

Phone

(253) 845-0585

Fax

(253) 845-1939

NPI assigned

May 3, 2007

Last updated

Mar 3, 2021By 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

Ms. Clysta C Prieto

Title

Bookkeeper

Phone

(253) 845-0587

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

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.

• Kenneth J Corliss, OD

  • Optometrist
  • Puyallup, WA
  • NPI 1316027048
  Medicare reassignment NPD

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614729600000",
    "number": "1932321296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1266",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983710237",
            "telephone_number": "253-845-0585",
            "fax_number": "253-845-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 4TH ST SE",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "98372",
            "telephone_number": "253-845-0585",
            "fax_number": "253-845-1939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORLISS OPTOMETRISTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A",
        "authorized_official_last_name": "PRIETO",
        "authorized_official_first_name": "CLYSTA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "BOOKKEEPER",
        "authorized_official_telephone_number": "253-845-0587",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "600080747",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR&INDUSTRIES",
            "identifier": "0016684",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2211704",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noah Arthur Cope, AU.D, CCC-A
• Caroline Brown Corbett, DDS
• Michelle Cordsen, LMP
• Corey Scott LMP, PLLC (Puyallup Valley Massage)
• David Aaron Edward Corey
• Dorothy Lea Corliss, R.D.H.
• Kenneth J Corliss, OD
• Frances J Corn, MSW
• Shannon Lin Cornell, PHARM.D
• Lisa Corriell, LMP

• Optometrist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.