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General NPI Number Information
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NPI Number | 1538282959
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Entity Type | Individual
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Provider Name | KENNETH ROSS MACMAHON O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 365 RENTON CENTER WAY SW SUITE D
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City | RENTON
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State | WA
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Zip | 98055-2324
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Country | US
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Telephone | 425-255-4630
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Fax | 425-255-4688
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Provider Business Mailing Address
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Address Line | 4123 178TH LN SE APT 3
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City | BELLEVUE
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State | WA
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Zip | 98008-5986
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3754
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License Number State | WA
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