Provider Demographics
NPI:1518168509
Name:MC KINNEY WHITEMARSH PLLC
Entity Type:Organization
Organization Name:MC KINNEY WHITEMARSH PLLC
Other - Org Name:THE VISUAL CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-479-2020
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2014-01-27
Deactivation Date:2009-04-27
Deactivation Code:
Reactivation Date:2009-06-30
Provider Licenses
StateLicense IDTaxonomies
WAOD00001135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033514Medicaid
WATO2144Medicare UPIN
WA2033514Medicaid
WAU81550Medicare UPIN