Provider Demographics
NPI:1104130871
Name:CANNON, MIRANDA MURRAY (OD)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:MURRAY
Last Name:CANNON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MIRANDA
Other - Middle Name:LYNN
Other - Last Name:MURRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2602 NE UNIVERSITY VILLAGE ST
Mailing Address - Street 2:SUITE B (AT MARKET OPTICAL)
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:206-525-3841
Practice Address - Street 1:2602 NE UNIVERSITY VILLAGE ST
Practice Address - Street 2:SUITE B (AT MARKET OPTICAL)
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5023
Practice Address - Country:US
Practice Address - Phone:206-522-9323
Practice Address - Fax:206-525-3841
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60160071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist