Individual provider Active NPI

Miranda Murray Cannon, O.D.

  • Optometrist
  • Seattle, WA
National Provider Identifier
1104130871
Registry record updated Jan 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
60160071 Issued in WA
Practice address
2602 NE University Village St
Suite B (at Market Optical)
Seattle, WA 98105-5023
Phone
(206) 522-9323
Fax
(206) 525-3841
NPI assigned
Aug 4, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 60160071 WA Primary

Addresses

Primary practice location

2602 NE University Village St
Suite B (at Market Optical)
Seattle, WA 98105-5023

Mailing address

2602 NE University Village St
Suite B (at Market Optical)
Seattle, WA 98105-5023
Phone (206) 522-9323

Other names 1

  • Miranda Lynn Murray Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140903000344 WA Practitioner - Optometry 3971721044 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Doctor Cannon PLLCGroup PAC ID 5991009417, 2 clinicians

Practice addresses (Care Compare)

2602 NE University Village St
Seattle, WA 98105-5023
Phone (206) 522-9323

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
60160071WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Doctor Cannon PLLC Optometrist CurrentSince Dec 26, 2015 Accepting new patients
Doctor Cannon PLLC Optometrist CurrentSince Dec 26, 2015 Accepting new patients

Locations

2602 NE University Village St
Ste B
Seattle, WA 98105
Phone (206) 522-9323

2602 NE University Village St
Seattle, WA 98105
Phone (206) 522-9323

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1280880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452556800000",
    "number": "1104130871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2602 NE UNIVERSITY VILLAGE ST",
            "address_2": "SUITE B (AT MARKET OPTICAL)",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981055023",
            "telephone_number": "206-522-9323",
            "fax_number": "206-525-3841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2602 NE UNIVERSITY VILLAGE ST",
            "address_2": "SUITE B (AT MARKET OPTICAL)",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981055023",
            "telephone_number": "206-522-9323",
            "fax_number": "206-525-3841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNON",
        "first_name": "MIRANDA",
        "middle_name": "MURRAY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-08-04",
        "last_updated": "2016-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60160071",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIRANDA",
            "last_name": "MURRAY",
            "middle_name": "LYNN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Seattle, WA

Sources for this page

Verify at the official NPI Registry.