Provider Demographics
NPI:1093098402
Name:MAYEMURA, INC.
Entity Type:Organization
Organization Name:MAYEMURA, INC.
Other - Org Name:MOUNTLAKE TERRACE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:KENJI
Authorized Official - Last Name:MAYEMURA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-778-0133
Mailing Address - Street 1:14050 JUANITA DR NE
Mailing Address - Street 2:STE. A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9708
Mailing Address - Country:US
Mailing Address - Phone:425-820-2020
Mailing Address - Fax:425-821-9576
Practice Address - Street 1:23009 56TH AVE W
Practice Address - Street 2:STE. A
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4713
Practice Address - Country:US
Practice Address - Phone:425-778-0133
Practice Address - Fax:425-778-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty