Individual provider Active NPI

Jason Guo, OD

  • Optometrist
  • Burien, WA
National Provider Identifier
1962074310
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OD61316792 Issued in WA
Practice address
15153 5TH Ave SW
Burien, WA 98166-3072
Phone
(206) 260-2503
Fax
(855) 929-1515
NPI assigned
Jul 14, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OD61316792 WA Primary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X OPT003350 GA

Addresses

Primary practice location

15153 5TH Ave SW
Burien, WA 98166-3072

Mailing address

34719 6TH Ave S
Federal Way, WA 98003-8714
Phone (206) 260-2503

Other practice location 1

34719 6th Ave S
Federal Way, WA 98003-8714
Phone (206) 260-2503

Other identifiers 1

IdentifierTypeStateIssuer
2231369MedicaidWA

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
I20230105000473 WA Practitioner - Optometry 6608246830 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Evergreen Eye Center PLLCGroup PAC ID 3173410057, 33 clinicians

Practice addresses (Care Compare)

15153 5TH Ave SW
Burien, WA 98166-3072
Phone (206) 212-2100

Merit-based Incentive Payment System (MIPS)

Final score
93.68 of 100Reported as group
Quality
100
Improvement activities
40
Cost
78.95

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT003350GAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Evergreen Eye Center, PLLC Optometrist CurrentSince Jan 1, 2023 Accepting new patients
Evergreen Eye Center, PLLC CurrentSince Jan 1, 2023 Accepting new patients
Evergreen Eye Center, PLLC Multi-Specialty Past Accepting new patients
Evergreen Eye Center, PLLC Optometrist Past Accepting new patients
Evergreen Eye Center, PLLC Past Accepting new patients
Retina Institute, PLLC Multi-Specialty Past Accepting new patients

Locations

34719 6th Ave S
Federal Way, WA 98003
Phone (206) 212-2100

502 S M St
Tacoma, WA 98405
Phone (253) 301-4953

Interoperability endpoints

  • Direct secure messaging: jason.guo.p41@direct.omnieyeatlanta.nextgenshare.com

Organizations & group practices 6

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": "1626220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704240000000",
    "number": "1962074310",
    "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": "206-260-2503",
            "fax_number": "855-929-1515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15153 5TH AVE SW",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981663072",
            "telephone_number": "206-260-2503",
            "fax_number": "855-929-1515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34719 6th Ave S",
            "address_purpose": "LOCATION",
            "city": "Federal Way",
            "state": "WA",
            "postal_code": "980038714",
            "country_code": "US",
            "telephone_number": "206-260-2503",
            "fax_number": "855-929-1515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUO",
        "first_name": "JASON",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-14",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD61316792",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT003350",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2231369",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burien, WA

Sources for this page

Verify at the official NPI Registry.