=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679723001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN'S EYE CARE, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2008
-----------------------------------------------------
Last Update Date | 05/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11800 NE 128TH ST STE 430
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-7299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-823-3937
-----------------------------------------------------
Fax | 425-823-7479
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11800 NE 128TH ST STE 430
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-7299
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-823-3937
-----------------------------------------------------
Fax | 425-823-7479
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PEDIATRIC OPHTHALMOLOGIST
-----------------------------------------------------
Name | KENNETH DAVID EPLEY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 425-823-3937
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207WX0110X
-----------------------------------------------------
Taxonomy Name | Pediatric Ophthalmology and Strabismus Specialist Physician Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------