Provision Eye Clinic, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

PROVISION EYE CLINIC, INC.

Practice address

17432 SE 270TH PL
Inside Walmart Vision Center
Covington, WA 98042-4962

Phone

(253) 630-8718

Fax

(253) 630-8720

NPI assigned

Sep 6, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Donald Leung, O.D.

Title

President

Phone

(312) 933-0078

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1315267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317427200000",
    "number": "1962783829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26229 125TH PL SE",
            "city": "KENT",
            "state": "WA",
            "postal_code": "980307976",
            "telephone_number": "312-933-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17432 SE 270TH PL",
            "address_2": "INSIDE WALMART VISION CENTER",
            "city": "COVINGTON",
            "state": "WA",
            "postal_code": "980424962",
            "telephone_number": "253-630-8718",
            "fax_number": "253-630-8720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION EYE CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-06",
        "last_updated": "2011-10-01",
        "status": "A",
        "authorized_official_last_name": "LEUNG",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-933-0078",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2011; 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.