MEDICARE: MAYEMURA INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	152WC0802X	Corneal and Contact Management Optometrist
2	152WX0102X	Occupational Vision Optometrist
3	152WP0200X	Pediatric Optometrist
4	152WS0006X	Sports Vision Optometrist
5	152WV0400X	Vision Therapy Optometrist
6	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932375979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYEMURA INC.

Provider Business Mailing Address
First Line	:	3202 W MCGRAW ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3208
Country	:	US
Telephone Number	:	206-284-5850
Fax Number	:	206-600-5850

Provider Business Practice Location Address
First Line	:	3202 W MCGRAW ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98199-3208
Country	:	US
Telephone Number	:	206-284-5850
Fax Number	:	206-600-5850

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. BRENDA BURDEN
Credential	:	O.D.
Telephone Number	:	206-284-5850

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	03/26/2009

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Directions to “MAYEMURA INC. ” Practice Location

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