Mark J Cannon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60160060 Issued in WA

Practice address

1906 Pike Place, #8-B
Seattle, WA 98101-1055

Phone

(206) 448-7739

Fax

(206) 448-4924

NPI assigned

Aug 21, 2010

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

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

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)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: drcannon@broadway-vision-source.direct.kno2fy.com

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.

• Doctor Cannon PLLC

  • Optometrist
  • Seattle, WA
  • NPI 1578983532
  Medicare reassignment Care Compare group NPD
• Jason a. Sifrit OD, Faao & Associates Inc.

  • Optometrist
  • Renton, WA
  • NPI 1558591727
  Medicare reassignment NPD
• Doctor Cannon PLLC

  • Optometrist
  • Seattle, WA
  • NPI 1023777067
  NPD
• Professional Provider Enterprise LLC

  • Optometrist
  • Omaha, NE
  • NPI 1770852196
  NPD (past)

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

{
    "created_epoch": "1282348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663632000000",
    "number": "1407162936",
    "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": "1906 PIKE PLACE, #8-B",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981011055",
            "telephone_number": "206-448-7739",
            "fax_number": "206-448-4924"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2602 NE University Village St",
            "address_2": "Suite B (at Market Optical)",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981055023",
            "country_code": "US",
            "telephone_number": "206-522-9323",
            "fax_number": "206-525-3841",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CANNON",
        "first_name": "MARK",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-21",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60160060",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew R. Cannizzaro, PT
• Chase Andrew Cannon
• Christopher P Cannon, MD
• Debra Cannon, LM
• Harriet Cannon, M.C.
• Miranda Murray Cannon, O.D.
• Patricia Anne Cannon, MA LMHC
• Richard Bigelow Cannon, M.D.
• Tawny Cannon, SUDPT
• Todd A Cannon, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2022; 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.