Provider Demographics
NPI:1336118496
Name:AYERS, KEVIN B (OD)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:B
Last Name:AYERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3700 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2636
Mailing Address - Country:US
Mailing Address - Phone:509-735-1312
Mailing Address - Fax:509-736-6403
Practice Address - Street 1:3700 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-2636
Practice Address - Country:US
Practice Address - Phone:509-735-1312
Practice Address - Fax:509-736-6403
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA1690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5239650001OtherDMERC REGION D
WADB9688OtherPALMETTO GBA RAILROAD MEDICARE
WA2004356Medicaid
WA146425100000OtherPREMERA BLUE CROSS
WA481279263AAOtherUNIFORM MEDICAL
WA146425100000OtherPREMERA BLUE CROSS