Blue Wave Eye Doctors Professional Limited Liability Company

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY

Practice address

3101 184TH St SW Ste 109&110
Lynnwood, WA 98037-4846

Phone

(726) 444-4122

NPI assigned

Dec 12, 2022

Organization subpart

No

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

Authorized official

Name

Dolsie McDonald

Title

Credentialing Manager

Phone

(726) 444-4078

Specialties & licenses 1

Addresses

Other names 1

• Visionworks Doctors of Optometry Doing business as

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

{
    "created_epoch": "1670803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677456000000",
    "number": "1972214765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "175 E HOUSTON ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782052299",
            "telephone_number": "726-444-4122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 184TH ST SW STE 109&110",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980374846",
            "telephone_number": "726-444-4122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-12",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "DOLSIE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "726-444-4078"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Visionworks Doctors of Optometry",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Visionworks Doctors of Optometry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.