Provider Demographics
NPI:1922095868
Name:PIATT, KENDAL RAE (OD)
Entity Type:Individual
Prefix:MISS
First Name:KENDAL
Middle Name:RAE
Last Name:PIATT
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 1:7401 W GRANDRIDGE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7831
Mailing Address - Country:US
Mailing Address - Phone:509-736-0710
Mailing Address - Fax:509-736-0751
Practice Address - Street 1:7401 W GRANDRIDGE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7831
Practice Address - Country:US
Practice Address - Phone:509-736-0710
Practice Address - Fax:509-736-0751
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3907TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA50524OtherDAVIS
WA2029742Medicaid
WAG8807239Medicare PIN
WA2029742Medicaid
WAV01417Medicare UPIN