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Deactivated NPI 1407077019 Deactivated / Inactive NPI Male Practitioner

Dr. Marious Kim Jack , MD

Optometrist • Seattle, WA

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Marious Jack has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date May 01, 2007
NPI Deactivation Date January 03, 2018
Total Practice Duration ~11 Years of Practice (2007 – 2018)

Professional Overview & Biography Verified Profile Summary

Dr. Marious Jack, MD was a registered Optometrist practicing in Seattle, WA. Throughout an active medical career spanning 11 years, Dr. Jack provided care at the practice location at 1101-A BOYLSTON AVE until profile deactivation on 2018-01-03.

Practice Location & Contact Primary Location

Practice Address

1101-A Boylston Ave

Seattle, WA 98101

Telephone 2063242006
Fax 2063250209

Specialty Benchmarks & Practice Insights

Comparative analytics for Optometrist in Seattle, WA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 18.5 Yrs
State Avg: 20.4 Yrs
Regional Practice Density
197 Specialists

Practicing in Seattle, WA (1692 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Optometrist Primary Specialty

NUCC Taxonomy Code: 152W00000X

State License WA MD5627

Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

1 Associated Practitioners
Merry Gonzales , LDO

Technician/Technologist - Optician

NPI 1780027672

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated January 03, 2018

Record deactivated on January 03, 2018

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1101-A BOYLSTON AVE, SEATTLE, WA 98101 (Tel: 2063242006)

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Updated Business Mailing Address July 08, 2007

Registered at 1101-A BOYLSTON AVE, SEATTLE, WA 98101 (Tel: 2063242006)

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Provider Name / Credentials Updated July 08, 2007

Recorded as MARIOUS JACK, MD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Optometrist (License #MD5627 in WA)

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Initial NPI Registration & Enumeration May 01, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1407077019
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: May 01, 2007
Last Update: July 08, 2007
Deactivation Date: January 03, 2018

Mailing Address

1101-A Boylston Ave

Seattle, WA 98101

Phone: 2063242006

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.