JENNIFER L KANNBERG NYBO (O.D.) – Optometrist, NPI 1073550281

JENNIFER L KANNBERG NYBO (O.D.) is a healthcare provider. based in Auburn, Washington. specializing in OPTOMETRY. They hold the professional credentials O.D.. They hold a License No. OD00003906 (WA). The NPI Number for JENNIFER L KANNBERG NYBO (O.D.) is 1073550281

Main info

Female
22 Years Of Experience
Accepts Medicare Assignment
Name
JENNIFER L KANNBERG NYBO (O.D.)
NPI
1073550281
Phone
(425) 985-8857
Address
30035 34TH AVE S
Enumeration Date
31 May 2006
Last Update Date
22 April 2021

Doctor Profile

Medical School Name
PACIFIC UNIVERSITY - COLLEGE OF OPTOMETRY
Secondary Phone
2534353100
Graduation Year
2004 (22 years ago)
PAC ID
4082687496
Group Practice PAC ID
9032022579
Professional Enrollment ID
I20040814000043
Address ID
WA983742192PU1007XSEXX400

Contacts

SOAP Endpoint
https://careepicwa.kp.org:14430/Interconnect-CE-PRD/wcf/epic.community.hie/xcpdrespondinggatewaysync
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience64
Completeness85
Years active:20State licenses:1Other namesUpdated within 12 months

1,098 OPTOMETRY in WA

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Provider Addresses for JENNIFER L KANNBERG NYBO (O.D.)

  • 30035, 34th Avenue South, Auburn, King County, Washington, 98001, United States

    AUBURN, WA 980012224

    Phone: (425) 985-8857

    Type: Mailing

  • 7724, Center Boulevard Southeast, Snoqualmie Ridge Town Center, Snoqualmie, King County, Washington, 98065, United States

    SNOQUALMIE, WA 980658993

    Phone: (425) 831-2060

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2004-08-14

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20040814000043IOptometryWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
92014Established patient complete exam of visual system1211$0
View full utilization report →

Insurance plans in this area (ZIP 98001)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9032022579View full group profile

Reviews

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Frequently asked questions

What unique ID ties claims to JENNIFER L KANNBERG NYBO (O.D.)?
NPI 1073550281 is assigned to JENNIFER L KANNBERG NYBO (O.D.) under the national enumeration system.
Is JENNIFER L KANNBERG NYBO (O.D.) active in the national directory?
JENNIFER L KANNBERG NYBO (O.D.)'s public NPI profile is in an active state.
What kind of provider is JENNIFER L KANNBERG NYBO (O.D.)?
The page reflects Optometrist for JENNIFER L KANNBERG NYBO (O.D.). Clinical services aligned with this taxonomy classification.
Where does public data place JENNIFER L KANNBERG NYBO (O.D.)?
The snapshot lists Auburn, Washington for JENNIFER L KANNBERG NYBO (O.D.); download NPPES for the complete set.
Is JENNIFER L KANNBERG NYBO (O.D.) a real provider?
This page reflects official NPPES data for NPI 1073550281. Always confirm identity and privileges with the practice and licensing boards.

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