Provider Demographics
NPI:1114922184
Name:MCKINNEY, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3433
Mailing Address - Country:US
Mailing Address - Phone:360-479-2020
Mailing Address - Fax:360-377-3642
Practice Address - Street 1:2816 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3433
Practice Address - Country:US
Practice Address - Phone:360-479-2020
Practice Address - Fax:360-377-3642
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT02144Medicare UPIN