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LAKE STEVENS
NPI 1376695551
Durable Medical Equipment & Medical Supplies in Lake Stevens, WA

Active since January 17, 2007CLIA 50D2292594 · Waiver
8910 VERNON ROAD, LAKE STEVENS, WA 98258(425) 335-0966 Get Directions Write a Review

NPPES record last updated: April 9, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Lake Stevens NPPES

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

LAKE STEVENS (NPI 1376695551) is a healthcare organization registered as a durable medical equipment & medical supplies in Lake Stevens, Washington and active in the NPI registry since January 2007. The organization holds a CLIA Waiver certificate valid through April 4, 2028 and lists George Go, Board President, as its authorized official.

NPPES Registry Identity

NPI1376695551
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameOPTUM CARE WASHINGTON PLLC
Location Address8910 VERNON ROADLake Stevens, WA 98258
Mailing AddressPo Box 5127Everett, WA 98206-5127
Phone(425) 335-0966
Organization SubpartYesParent: Everett Physicians, Inc. P.s.
Authorized OfficialGeorge GoBoard President · (425) 259-0966
Enumeration DateJanuary 17, 2007
Last NPPES UpdateApril 9, 2024
NPPES CertifiedApril 9, 2024
✔ NPI 1376695551 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition

A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

8910 VERNON ROAD, Lake Stevens, WA 98258
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Other Names 1

Other NameLake Stevens

Other Identifiers 2

Other33000WA · L&i
Medicaid7776503WA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 50D2292594

Lake Stevens Manor Adult Family Home LLC · Lake Stevens, WA
Active · expires Apr 4, 2028
CLIA Number50D2292594
Laboratory TypeAfh
Certificate Effective DateOctober 26, 2023
Certificate Expiration DateApril 4, 2028
Laboratory DirectorKlinnie Nyale
Laboratory Phone(425) 374-7443
Laboratory LocationLake Stevens Manor Adult Family Home LLC2505 121st Dr NE, Lake Stevens, WA 98258
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GLENN ANDREW MAHONEY PAC
Physician Assistant (Medical)
8910 VERNON ROAD
LAKE STEVENS, WA 98258
Snohomish County (425) 335-0966

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 Optum Care Washington PLLC's NPI number?

The NPI number for Optum Care Washington PLLC is 1376695551. It was assigned to this organization in the NPPES registry on January 17, 2007. The provider is also known as Lake Stevens.

Where is Optum Care Washington PLLC located?

Optum Care Washington PLLC is located at 8910 Vernon Road, Lake Stevens, WA 98258. The listed phone number is (425) 335-0966.

What is Optum Care Washington PLLC's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Does Optum Care Washington PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 50D2292594) is associated with this NPI, valid through April 4, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Optum Care Washington PLLC was last updated on April 9, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.