Provider Demographics
NPI:1841549276
Name:MCKINNEY, ANDREA (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:
Last Name:MCKINNEY
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 1:2502 196TH ST SW STE 114
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7091
Mailing Address - Country:US
Mailing Address - Phone:425-771-2662
Mailing Address - Fax:
Practice Address - Street 1:2502 196TH ST SW STE 114
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-7091
Practice Address - Country:US
Practice Address - Phone:425-771-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2018-02-14
Deactivation Date:2017-12-28
Deactivation Code:
Reactivation Date:2018-01-23
Provider Licenses
StateLicense IDTaxonomies
WAOD60294865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023596Medicaid