| Kenneth D. Common, O.d., P.s. | |
|
625 Black Lake Blvd Sw Suite #110 Olympia WA 98502-5066 | |
| (360) 357-2544 | |
| (360) 357-6341 |
| Full Name | Kenneth D. Common, O.d., P.s. |
|---|---|
| Speciality | Clinic/center |
| Location | 625 Black Lake Blvd Sw, Olympia, Washington |
| Authorized Official Name and Position | Kenneth Douglas Common (PRESIDENT) |
| Authorized Official Contact | 3603572544 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kenneth D. Common, O.d., P.s. 625 Black Lake Blvd Sw Suite #110 Olympia WA 98502-5066 Ph: (360) 357-2544 | Kenneth D. Common, O.d., P.s. 625 Black Lake Blvd Sw Suite #110 Olympia WA 98502-5066 Ph: (360) 357-2544 |
| NPI Number | 1811052798 |
|---|---|
| Provider Enumeration Date | 12/22/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811052798 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 1155 (Washington) | Primary |
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