Individual
DR. KENNETH J CORLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
312 4TH ST SE, UNIT A, PUYALLUP, WA 98372-3269
(253) 845-0585
(253) 845-1939
Mailing address
PO BOX 1266, PUYALLUP, WA 98371-0237
(253) 845-0585
(253) 845-1939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD915
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016684
L & I
WA
05
—
2211704
—
WA
Enumeration date
10/17/2006
Last updated
03/03/2020
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