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General NPI Number Information
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NPI Number | 1578983532
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Entity Type | Organization
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Legal Business Name | DOCTOR CANNON PLLC
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Dates
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Enumeration Date | 04/17/2014
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Last Update Date | 09/20/2022
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Provider Practice Location Address
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Address Line | 2602 NE UNIVERSITY VILLAGE ST SUITE B (AT MARKET OPTICAL)
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City | SEATTLE
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State | WA
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Zip | 98105-5023
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Country | US
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Telephone | 206-522-9323
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Fax | 206-525-3841
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Provider Business Mailing Address
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Address Line | 2602 NE UNIVERSITY VILLAGE ST SUITE B (AT MARKET OPTICAL)
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City | SEATTLE
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State | WA
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Zip | 98105-5023
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Country | US
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Telephone | 206-522-9323
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Fax | 206-525-3841
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Authorized Official
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Title or Position | MEMBER
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Name | DR. MIRANDA CANNON
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Credential | O.D.
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Telephone | 206-714-8606
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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 |
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License Number State | WA
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