Kenneth D. Common, O.D., P.S.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

1155 Issued in WA

Legal business name

KENNETH D. COMMON, O.D., P.S.

Practice address

625 Black Lake Blvd SW
Suite #110
Olympia, WA 98502-5066

Phone

(360) 357-2544

Fax

(360) 357-6341

NPI assigned

Dec 22, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Douglas Common, O.D.NPI 1851402085

Title

President

Phone

(360) 357-2544

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth Douglas Common, O.D.

  • Optometrist
  • Olympia, WA
  • NPI 1851402085
  NPD (past) Authorized official

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

{
    "created_epoch": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1811052798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 BLACK LAKE BLVD SW",
            "address_2": "SUITE #110",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025066",
            "telephone_number": "360-357-2544",
            "fax_number": "360-357-6341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 BLACK LAKE BLVD SW",
            "address_2": "SUITE #110",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025066",
            "telephone_number": "360-357-2544",
            "fax_number": "360-357-6341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH D. COMMON, O.D., P.S.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "COMMON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "360-357-2544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "1155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elise Kennedy, LMP
• Irisa Kennedy
• Nancy J. Kennedy, O.D.
• Richard P Kennedy, MD
• Vaira Kennedy
• Kenneth Hancock DDS, PLLC
• Mitchel V Kent
• Jennifer Tracy Kenworthy
• Stephen Bonney Kern, D.M.D.
• Kerry J Dyer Lac PLLC (Judd Acupuncture and Healing Arts)

• Clinic/Center in Olympia, WA
• Providers in Olympia, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.