| Evergreen Eye Center, Pllc | |
|
34719 6th Ave S, Federal Way, WA 98003-8714 | |
| (206) 212-2100 | |
| (206) 212-2194 |
| Full Name | Evergreen Eye Center, Pllc |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 34719 6th Ave S, Federal Way, Washington |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700959293 | NPI | - | NPPES |
| 0870427 | Other | WA | AETNA NUMBER |
| WA0527 | Other | WA | EEC NBN NUMBER |
| 891451 | Other | WA | CRIME VICTIMS EEC NUMBER |
| EV8144 | Other | WA | EEC KCM GROUP NUMBER |
| 59460 | Other | WA | EEC L&I NUMBER |
| 7080781 | Medicaid | WA | |
| 2017242 | Medicaid | WA | |
| P04799 | Other | WA | PCMB GROUP EEC NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Provider Name | John T Heffernan |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1093791121 PECOS PAC ID: 4981599313 Enrollment ID: I20040607000975 |
| Provider Name | Robert A Tester |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1689783268 PECOS PAC ID: 4587641881 Enrollment ID: I20040706000267 |
| Provider Name | Anita S Lam |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1417933250 PECOS PAC ID: 7810967460 Enrollment ID: I20040729001324 |
| Provider Name | Theodore M Zollman |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1003925785 PECOS PAC ID: 1759352123 Enrollment ID: I20040802000544 |
| Provider Name | Annisa L Jamil |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1629006135 PECOS PAC ID: 6406822618 Enrollment ID: I20050714001014 |
| Provider Name | Gary W Chung |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1275642779 PECOS PAC ID: 3678540614 Enrollment ID: I20050801000825 |
| Provider Name | Andrew B Kopstein |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1124050117 PECOS PAC ID: 8224050836 Enrollment ID: I20051223000186 |
| Provider Name | Jeanna M Hoyt |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1548246689 PECOS PAC ID: 3779478102 Enrollment ID: I20080514000776 |
| Provider Name | Brant F Carroll |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1154307999 PECOS PAC ID: 2062307499 Enrollment ID: I20080516000182 |
| Provider Name | John J Whitehead |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1891866679 PECOS PAC ID: 0941370126 Enrollment ID: I20090727000195 |
| Provider Name | Daniel P Kelly |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1578541090 PECOS PAC ID: 4284529611 Enrollment ID: I20100309000522 |
| Provider Name | Anastasia L Porter |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1922164607 PECOS PAC ID: 0345262952 Enrollment ID: I20120131000875 |
| Provider Name | Brice R Nicholson |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1508837584 PECOS PAC ID: 8022279892 Enrollment ID: I20120423000429 |
| Provider Name | Bradley A Frederickson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1174631899 PECOS PAC ID: 6608038013 Enrollment ID: I20120501000708 |
| Provider Name | James Santoro |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1578799292 PECOS PAC ID: 6406002104 Enrollment ID: I20120813000470 |
| Provider Name | Kelly Minh-thy Bui |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1235367103 PECOS PAC ID: 7911147764 Enrollment ID: I20140730002724 |
| Provider Name | Jessica Leah Scherer |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1457728479 PECOS PAC ID: 2961712914 Enrollment ID: I20151104000695 |
| Provider Name | Erin Seefeldt |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1629225024 PECOS PAC ID: 5698905560 Enrollment ID: I20170712002871 |
| Provider Name | Alexander L Grigalunas |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1013279298 PECOS PAC ID: 6002186533 Enrollment ID: I20170717001687 |
| Provider Name | Vanessa Margaretta Franklin |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1730538059 PECOS PAC ID: 8325316854 Enrollment ID: I20170906001102 |
| Provider Name | Thao Phuong H Le |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1578906988 PECOS PAC ID: 8325282270 Enrollment ID: I20180816002002 |
| Provider Name | Richard Anthony Beller |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1396741005 PECOS PAC ID: 7012985310 Enrollment ID: I20190308002031 |
| Provider Name | Nathan Derek Wilbanks |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1801275490 PECOS PAC ID: 2961737705 Enrollment ID: I20190716001450 |
| Provider Name | Mckenzie Suzanne Fogarty |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1063995181 PECOS PAC ID: 9931439353 Enrollment ID: I20190927002480 |
| Provider Name | Shawn Nash |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1801203088 PECOS PAC ID: 0648586917 Enrollment ID: I20191212000910 |
| Provider Name | Thomas Copperman |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1710220330 PECOS PAC ID: 9739323585 Enrollment ID: I20200323003295 |
| Provider Name | Roger Allan Anderson |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1598797979 PECOS PAC ID: 5890882781 Enrollment ID: I20200327003197 |
| Provider Name | Erica Julia Uman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1629613146 PECOS PAC ID: 9638504749 Enrollment ID: I20210615001144 |
| Provider Name | Vy Ha |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1497375935 PECOS PAC ID: 8325446016 Enrollment ID: I20211011001979 |
| Provider Name | Matthew R Cardinale |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1982145819 PECOS PAC ID: 8224441167 Enrollment ID: I20211115001792 |
| Provider Name | Joshua Frenkel |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1356752091 PECOS PAC ID: 5597050971 Enrollment ID: I20220209000605 |
| Provider Name | Timothy G Mock |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1063961654 PECOS PAC ID: 1153669890 Enrollment ID: I20221003002936 |
| Provider Name | Alexandra Matejczyk |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1629733092 PECOS PAC ID: 8921475914 Enrollment ID: I20221103002338 |
| Provider Name | Jason Guo |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1962074310 PECOS PAC ID: 6608246830 Enrollment ID: I20230105000473 |
| Provider Name | Christina Lieu |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1689179293 PECOS PAC ID: 3678829447 Enrollment ID: I20230815002936 |
| Provider Name | Christopher Dean Johnson |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1568861425 PECOS PAC ID: 4486984804 Enrollment ID: I20240717000896 |
| Provider Name | Kevin Jackson |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1538662374 PECOS PAC ID: 7810378346 Enrollment ID: I20250519003564 |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Eye Center, Pllc 34719 6th Ave S, Federal Way, WA 98003-8714 Ph: (206) 212-2100 | Evergreen Eye Center, Pllc 34719 6th Ave S, Federal Way, WA 98003-8714 Ph: (206) 212-2100 |