Provider Demographics
NPI:1427299056
Name:MAYEMURA, INC.
Entity type:Organization
Organization Name:MAYEMURA, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEN
Authorized Official - Middle Name:KENJI
Authorized Official - Last Name:MAYEMURA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-820-2020
Mailing Address - Street 1:14050 JUANITA DR NE
Mailing Address - Street 2:STE. A
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-5308
Mailing Address - Country:US
Mailing Address - Phone:425-820-2020
Mailing Address - Fax:
Practice Address - Street 1:14050 JUANITA DR NE
Practice Address - Street 2:STE. A
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-5308
Practice Address - Country:US
Practice Address - Phone:425-820-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-11
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
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU58847Medicare UPIN