Provider Demographics
NPI:1497057459
Name:ATKINSON, KILAH SHEA (OD)
Entity Type:Individual
Prefix:MRS
First Name:KILAH
Middle Name:SHEA
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 918
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-0206
Mailing Address - Country:US
Mailing Address - Phone:541-923-2221
Mailing Address - Fax:541-923-3776
Practice Address - Street 1:443 SW EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2817
Practice Address - Country:US
Practice Address - Phone:541-923-2221
Practice Address - Fax:541-923-3776
Is Sole Proprietor?:No
Enumeration Date:2010-11-24
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3434ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500642657Medicaid