Kenneth J Corliss, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD915 Issued in WA

Practice address

312 4TH St SE
Unit a
Puyallup, WA 98372-3269

Phone

(253) 845-0585

Fax

(253) 845-1939

NPI assigned

Oct 17, 2006

Last updated

Mar 3, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 1970

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Corliss Optometrists

  • Optometrist
  • Puyallup, WA
  • NPI 1932321296
  Medicare reassignment NPD

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

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583193600000",
    "number": "1316027048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1266",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983710237",
            "telephone_number": "253-845-0585",
            "fax_number": "253-845-1939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 4TH ST SE",
            "address_2": "UNIT A",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983723269",
            "telephone_number": "253-845-0585",
            "fax_number": "253-845-1939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CORLISS",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-03-03",
        "certification_date": "2020-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD915",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2211704",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0016684",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Cordsen, LMP
• Corey Scott LMP, PLLC (Puyallup Valley Massage)
• David Aaron Edward Corey
• Corliss Optometrists
• Dorothy Lea Corliss, R.D.H.
• Frances J Corn, MSW
• Shannon Lin Cornell, PHARM.D
• Lisa Corriell, LMP
• Ashley Cort
• Laura Ashley Cortez, MS, CCC-SLP

• Optometrist in Puyallup, WA
• Providers in Puyallup, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.