Healthcare Provider Details

I. General information

NPI: 1306178298
Provider Name (Legal Business Name): DR KATHLEEN M KINNEY, OD, PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 3RD AVE SUITE 411
SEATTLE WA
98101-3635
US

IV. Provider business mailing address

1511 3RD AVE SUITE 411
SEATTLE WA
98101-3635
US

V. Phone/Fax

Practice location:
  • Phone: 206-624-0737
  • Fax: 206-626-0878
Mailing address:
  • Phone: 206-624-0737
  • Fax: 206-626-0878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. KATHLEEN M KINNEY
Title or Position: PRESIDENT
Credential: OD
Phone: 206-624-0737