Provider Demographics
NPI:1689857690
Name:MAYEMURA, INC.
Entity Type:Organization
Organization Name:MAYEMURA, INC.
Other - Org Name:EVERETT FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-353-5544
Mailing Address - Street 1:9610 EVERGREEN WAY
Mailing Address - Street 2:STE. A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98204-7102
Mailing Address - Country:US
Mailing Address - Phone:425-353-5544
Mailing Address - Fax:206-350-5544
Practice Address - Street 1:9610 EVERGREEN WAY
Practice Address - Street 2:STE. A
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-7102
Practice Address - Country:US
Practice Address - Phone:425-353-5544
Practice Address - Fax:206-350-5544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028751Medicaid
WA8802344Medicare PIN