DR. KENNETH DOUGLAS COMMON (NPI# 1851402085) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851402085 |
| Entity Type | Individual |
| Full Name | DR. KENNETH DOUGLAS COMMON |
| Credential | O.D. |
| Practice Address |
625 Black Lake Blvd Sw Suite #110 Olympia WA 98502-5066 |
| Mailing Address |
12804 Se 302nd St Auburn WA 98092-2172 |
| Practice Telephone | 3603572544 |
| Practice Fax Number | 3603576341 |
| Mailing Telephone | 2538879174 |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-05-21 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 1155TX | WA | Eye and Vision Services Providers |
| Street Address |
625 BLACK LAKE BLVD SW SUITE #110 |
| City | OLYMPIA |
| State | WA |
| Zip Code | 98502-5066 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184004749 | Joseph Beaushaw | Optometrist | 625 Black Lake Blvd Sw, Olympia, WA 98502-5066 | 2015-06-08 |
| 1780987313 | Angela Loeb, Od, Pllc | Optometrist | 625 Black Lake Blvd Sw, Suite 369, Olympia, WA 98502-5066 | 2010-12-21 |
| 1457665739 | Angela Caterina Loeb | Optometrist | 625 Black Lake Blvd Sw, Suite 369, Olympia, WA 98502-5066 | 2010-07-29 |
| 1487700407 | Dr. Dallas Carr and Associates | Clinic/Center | 625 Black Lake Blvd Sw, Suite 110, Olympia, WA 98502-5066 | 2007-01-25 |
| 1811052798 | Kenneth D. Common, O.d., P.s. | Clinic/Center | 625 Black Lake Blvd Sw, Suite #110, Olympia, WA 98502-5066 | 2006-12-22 |
| 1073674230 | Jay Woodworth Nelson | Optometrist | 625 Black Lake Blvd Sw, Olympia, WA 98502-5066 | 2006-12-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801409172 | Fanny Cordero | Interpreter | 1415 4th Ave W, Olympia, WA 98502 | 2020-08-26 |
| 1235762832 | Accessible Living Physical Therapy | Clinic/Center | 3524 7th Ave Se, Olympia, WA 98502 | 2020-02-21 |
| 1548807738 | Kaiser Foundation Health Plan of Washington | Pharmacy | 1200 Cooper Point Road Sw, Suite 100, Olympia, WA 98502 | 2019-12-06 |
| 1851946388 | Katherine Ann Vitela | Registered Nurse | 4909 Green Wood Dr Sw, Olympia, WA 98502 | 2019-08-01 |
| 1538632658 | Carmen Rae Breding | Massage Therapist | 2627 Capital Mall Dr Se, Olympia, WA 98502 | 2019-01-11 |
| 1285129155 | Fook Yee Cheung | Genetic Counselor, MS | 2010 Caton Way Sw Ste 102, Olympia, WA 98502 | 2018-06-24 |
| 1942724158 | William Coburn | Specialist/Technologist | 703 Lilly Road Ne, Suite 104, Olympia, WA 98502 | 2017-07-29 |
| 1225567415 | Thierry Buckner | Counselor | 2400 Bristol Court Sw, Olympia, WA 98502 | 2017-06-09 |
| 1619406048 | Trenton Reid | Massage Therapist | 2103 Harrison Ave Nw #2642, Olympia, WA 98502 | 2017-06-08 |
| 1962807305 | Richa Mehta | Dentist | 1530 Black Lake Boulevard, Suite A103, Olympia, WA 98502 | 2014-10-28 |
| Find all providers in zip 98502 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649571118 | Brian Paul Finley | Optometrist | 3612 Wesley Dr Nw, Olympia, WA 98502-3746 | 2010-11-15 |
| 1386836591 | Van B. Ly | Optometrist | 319 7th Ave Se, Suite #101, Olympia, WA 98501-1325 | 2007-08-11 |
| 1811015688 | Richard Duane Hehn | Optometrist | 651 Sleater Kinney Se, Suite 1300, Olympia, WA 98503 | 2007-03-27 |
| 1205961836 | Kornmesser Optometry Clinic Inc Ps | Optometrist | 1405 Harrison Ave Nw Ste 101, Olympia, WA 98502-5327 | 2007-02-23 |
| 1881754182 | Dr. Kimberly Carr-yeates, O.d., P.s. | Optometrist | 625 Black Lake Blvd Sw Ste 369, Olympia, WA 98502-8606 | 2006-12-11 |
| 1275609463 | Ben Harold Wong Jr. | Optometrist | 1940 Black Lake Blvd Sw, Olympia, WA 98512-5651 | 2006-11-28 |
| 1407963770 | Reid I Mamiya | Optometrist | 115 New View Ct Ne, Olympia, WA 98506-5250 | 2006-08-24 |
| 1508894007 | Susan M Dini | Optometrist | 2939 Benjamin Ct Se, Olympia, WA 98501-4807 | 2006-06-30 |
| 1770560708 | Michael D Moore | Optometrist | 2600 Martin Way E, Ste C, Olympia, WA 98506-4974 | 2005-12-30 |
| 1114903937 | Kimberly A Carr-yeates | Optometrist | 1510 Cooper Point Rd Sw, Ste 110, Olympia, WA 98502-5734 | 2005-12-22 |
| Find all providers in OLYMPIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.