Kenneth Douglas Common, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1155TX Issued in WA

Practice address

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

Phone

(360) 357-2544

Fax

(360) 357-6341

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Kenneth D. Common, O.D., P.S.

  • Clinic/Center
  • Olympia, WA
  • NPI 1811052798
  NPD (past) Authorized official
• Brent Chin OD Inc PS

  • Corneal and Contact Management Optometrist
  • Federal Way, WA
  • NPI 1003970823
  NPD (past)
• Federal Way Vision Center

  • Optometrist
  • Federal Way, WA
  • NPI 1336210483
  NPD (past)
• Van B. Ly, LLC

  • Clinic/Center
  • Olympia, WA
  • NPI 1154585024
  NPD (past)

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211328000000",
    "number": "1851402085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12804 SE 302ND ST",
            "city": "AUBURN",
            "state": "WA",
            "postal_code": "980922172",
            "telephone_number": "253-887-9174"
        },
        {
            "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": {
        "last_name": "COMMON",
        "first_name": "KENNETH",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "1155TX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Columbia Capital Medical Center (Capital Medical Center)
• Columbia Capital Medical Center LP (Capital Medical Center)
• Columbia Capital Medical Center, LP (Capital Medical Center)
• Rebecca A Combs, LMP
• Kelly Lynn Comeau
• Community Chiropractic PS
• Community Health Outreach (Jeanette Revay)
• Community Youth Services
• Compassionate Pathways Psychology Services, LLC
• Compassionate Psychiatry, PLLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2008; 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.