=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659230068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANTA ELENA HAGER EYE CARE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2026
-----------------------------------------------------
Last Update Date | 02/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23714 222ND PL SE STE B
-----------------------------------------------------
City | MAPLE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98038-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-432-1206
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23714 222ND PL SE STE B
-----------------------------------------------------
City | MAPLE VALLEY
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98038-5800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-432-1206
-----------------------------------------------------
Fax | 425-413-4465
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST
-----------------------------------------------------
Name | DR. MARIENNE ALYSSA SANTA ELENA
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 503-719-1213
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------