Provider Demographics
NPI:1487764585
Name:DEAN, KEVIN GEORGE (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:GEORGE
Last Name:DEAN
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 1:6600 W NOB HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1976
Mailing Address - Country:US
Mailing Address - Phone:509-895-5366
Mailing Address - Fax:509-965-1890
Practice Address - Street 1:6600 W NOB HILL BLVD
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1976
Practice Address - Country:US
Practice Address - Phone:509-895-5366
Practice Address - Fax:509-965-1890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1896AT152W00000X
WAOD00001781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist