Provider Demographics
NPI:1023777067
Name:DOCTOR CANNON PLLC
Entity type:Organization
Organization Name:DOCTOR CANNON PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRANDA
Authorized Official - Middle Name:MURRAY
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-522-9323
Mailing Address - Street 1:2602 NE UNIVERSITY VILLAGE ST STE B
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5023
Mailing Address - Country:US
Mailing Address - Phone:206-522-9323
Mailing Address - Fax:206-522-9323
Practice Address - Street 1:1906 PIKE PLACE, SUITE 8-B
Practice Address - Street 2:AT MARKET OPTICAL
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1055
Practice Address - Country:US
Practice Address - Phone:206-448-7739
Practice Address - Fax:206-448-4924
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOCTOR CANNON PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-12-16
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty