Provider Demographics
NPI:1366553141
Name:ATKINS, KERRY MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:KERRY
Middle Name:MARTIN
Last Name:ATKINS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 6TH ST S
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-6712
Mailing Address - Country:US
Mailing Address - Phone:425-822-7685
Mailing Address - Fax:425-889-1664
Practice Address - Street 1:941 6TH ST S
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6712
Practice Address - Country:US
Practice Address - Phone:425-822-7685
Practice Address - Fax:425-889-1664
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA 1750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011187Medicaid
WAGAB22873Medicare PIN