Central Washington Eye Clinic PLLC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

MD00038596 Issued in WA

Legal business name

CENTRAL WASHINGTON EYE CLINIC PLLC

Practice address

425 SW 41St St
Renton, WA 98057-4926

Phone

(425) 255-4250

Fax

(425) 271-3294

NPI assigned

May 26, 2006

Reactivated

Mar 25, 2021

Organization subpart

Yes

Parent organization

CENTRAL WASHINGTON EYE CLINIC PLLCAs reported in NPPES

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

Authorized official

Name

Dr. Abel Li, M.D.NPI 1841239399

Title

Owner

Phone

(425) 255-4250

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Washington Valley Eye & Laser Center Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Tax ID family

Central Washington Eye2 organizations share this tax ID, including this one

Part of

Central Washington Eye

Other organizations with this tax ID 1

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

• Central Washington Eye Clinic PLLC

  • Ophthalmologic Surgery Clinic/Center
  • Renton, WA
  • NPI 1801409677
  NPD tax ID

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Central Washington Eye Clinic PLLC

  • Ophthalmologic Surgery Clinic/Center
  • Renton, WA
  • NPI 1801409677

  Member Of

  NPD member

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Abel Li, M.D.

  • Ophthalmology Physician
  • Yakima, WA
  • NPI 1841239399
  Medicare reassignment NPD Authorized official
• Melissa Sun Cho, OD

  • Optometrist
  • Seattle, WA
  • NPI 1285865626
  Medicare reassignment NPD
• Steven Matthew Ming-Hao Tan, OD

  • Optometrist
  • Woodinville, WA
  • NPI 1689392342
  Medicare reassignment NPD

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623628800000",
    "number": "1972559458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 CREEKSIDE LOOP",
            "address_2": "SUITE 110",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989024876",
            "telephone_number": "509-452-6611",
            "fax_number": "509-248-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 SW 41ST ST",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980574926",
            "telephone_number": "425-255-4250",
            "fax_number": "425-271-3294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL WASHINGTON EYE CLINIC PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRAL WASHINGTON EYE CLINIC PLLC",
        "enumeration_date": "2006-05-26",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "deactivation_date": "2021-03-03",
        "reactivation_date": "2021-03-25",
        "status": "A",
        "authorized_official_last_name": "LI",
        "authorized_official_first_name": "ABEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "425-255-4250",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "WA",
            "license": "MD00038596",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "CE3333",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7114580",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR AND INDUSTRIES",
            "identifier": "135530",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180045644",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRIME VICTIMS",
            "identifier": "8933290",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "manager@centralwaeye.com",
            "affiliation": "N",
            "address_1": "3902 Creekside Loop",
            "address_2": "Suite 110",
            "city": "Yakima",
            "state": "WA",
            "country_code": "US",
            "postal_code": "989024876",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Washington Valley Eye & Laser Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Washington Valley Eye & Laser Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Ophthalmology Physician in Renton, WA
• Providers in Renton, WA by specialty
• Ophthalmology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.