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BONNEY LAKE OPTICAL, INC
NPI 1154478014
Optometrist - Pediatrics in Bonney Lake, WA

Active since January 04, 2007
19205 STATE ROUTE 410 E, BONNEY LAKE, WA 98391(253) 826-9156(253) 826-9158 Get Directions Write a Review

NPPES record last updated: September 2, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Sep 2, 2026, Jan 31, 2023 (2 updates tracked since 2023).

About Bonney Lake Optical, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BONNEY LAKE OPTICAL, INC (NPI 1154478014), doing business as Emerald Eye Care, is a healthcare organization registered as a pediatrics in Bonney Lake, Washington and active in the NPI registry since January 2007. The organization maintains a secondary practice location in Renton and lists Sean Cudahy, Cfo, as its authorized official.

NPPES Registry Identity

NPI1154478014
Entity TypeOrganization
Primary Taxonomy152WP0200X
Legal Business NameBONNEY LAKE OPTICAL, INC
Location Address19205 STATE ROUTE 410 EBonney Lake, WA 98391-6305
Mailing AddressPo Box 2139Orting, WA 98360-2139 · (253) 826-9156 · Fax (253) 826-9158
Phone(253) 826-9156
Fax(253) 826-9158
Organization SubpartNo
Authorized OfficialSean CudahyCfo · (253) 750-8135
Enumeration DateJanuary 4, 2007
Last NPPES UpdateSeptember 2, 20262 updates tracked since enumeration
NPPES CertifiedSeptember 2, 2026
✔ NPI 1154478014 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyOptometrist · PediatricsEye and Vision Services Providers
Taxonomy Code152WP0200X
Definition
Optometrists who work in Pediatrics are concerned with the prevention, development, diagnosis, and treatment of visual problems in children.
Also ListedOptometristTaxonomy 152W00000X
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X · License 1641 (WA)
19205 STATE ROUTE 410 E, Bonney Lake, WA 98391
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Other Names 1

Doing Business AsEmerald Eye Care

Secondary Practice Location 1

Location 1743 Rainier Ave SRenton, WA 98057-3204 · Phone (425) 227-9170

Other Identifiers 1

Medicaid2009926WA

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Premera Blue Cross Blue Shield of Alaska.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Bonney Lake Optical, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Bonney Lake Optical, Inc, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Bruce Cudahy, O.D.
Optometry
NPI 1457321135
9801 204TH AVE E
Bonney Lake, WA 98391
(253) 750-8135
✔ PECOS✔ Accepts Medicare0.6 mi
Sean Cudahy, O.D.
Optometry
NPI 1841641719
9801 204TH AVE E
Bonney Lake, WA 98391
(253) 750-8135
✔ PECOS✔ Accepts Medicare0.6 mi
Prabhdeep Johal
Optometry
NPI 1801411574
32717 1ST AVE S STE 6
Federal Way, WA 98003
(253) 838-5428
✔ PECOS12 mi
Jasonpreet Dhaliwal, OD
Optometry
NPI 1972176006
1801 10TH AVE NW
Issaquah, WA 98027
(425) 369-6726
✔ PECOS27 mi
Mahin Khadeer, O.D
Optometry
NPI 1306585179
3025 112TH AVE NE SUITE 200
Bellevue, WA 98004
(800) 925-2020
✔ PECOS✔ Accepts Medicare32 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bonney Lake Optical, Inc's NPI number?

The NPI number for Bonney Lake Optical, Inc is 1154478014. It was assigned to this organization in the NPPES registry on January 4, 2007. The provider is doing business as Emerald Eye Care.

Where is Bonney Lake Optical, Inc located?

Bonney Lake Optical, Inc is located at 19205 State Route 410 E, Bonney Lake, WA 98391. The listed phone number is (253) 826-9156.

What is Bonney Lake Optical, Inc's specialty?

The primary specialty registered for this NPI is Optometrist, specializing in Pediatrics, with taxonomy code 152WP0200X.

Is Bonney Lake Optical, Inc enrolled in Medicare?

Yes. Bonney Lake Optical, Inc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Bonney Lake Optical, Inc?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians, all in Optometry, reassign their Medicare billing to Bonney Lake Optical, Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Bonney Lake Optical, Inc accept?

Health plans from Premera Blue Cross Blue Shield of Alaska list Bonney Lake Optical, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Bonney Lake Optical, Inc was last updated on September 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.