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General NPI Number Information
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NPI Number | 1720285059
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Entity Type | Organization
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Legal Business Name | MC KINNEY WHITEMARSH PLLC
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Dates
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Enumeration Date | 06/29/2007
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 23160 ST HWY 3
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City | BELFAIR
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State | WA
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Zip | 98528
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Country | US
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Telephone | 360-275-2020
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Fax | 360-275-6848
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Provider Business Mailing Address
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Address Line | PO BOX 505
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City | BELFAIR
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State | WA
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Zip | 98528-0505
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Country | US
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Telephone | 360-275-2020
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Fax | 360-275-6848
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL MCKINNEY
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Credential | O.D.
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Telephone | 360-275-2020
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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 | OD00001135
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License Number State | WA
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