Organization
KENNETH D. COMMON, O.D., P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH DOUGLAS COMMON O.D. (PRESIDENT)
(360) 357-2544
Entity
Organization
Contact information
Practice address
625 BLACK LAKE BLVD SW, SUITE #110, OLYMPIA, WA 98502-5066
(360) 357-2544
(360) 357-6341
Mailing address
625 BLACK LAKE BLVD SW, SUITE #110, OLYMPIA, WA 98502-5066
(360) 357-2544
(360) 357-6341
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1155
WA
Other
Enumeration date
12/22/2006
Last updated
08/22/2020
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