Corliss, Kenneth J
Corliss, Kenneth J is an individual health care provider with primary practice located at 312 4Th St Se Unit A, Puyallup WA 98372-3269. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Corliss, Kenneth J can be contacted via phone (253) 845-0585.Contact Information
Primary practice address
312 4Th St Se Unit A
Puyallup WA 98372-3269
Phone: (253) 845-0585
Fax: (253) 845-1939
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OD915 | Washington |
Profile Details
| NPI number | 1316027048 |
|---|---|
| LBN Legal business name | Corliss, Kenneth J |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 17th, 2006 |
| Last updated | Mar 3rd, 2020 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316027048 | NPPES |
| Washington | MEDICAID | 2211704 | |
| Washington | Other | 0016684 |
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