Edgar Crockett OD PS
Organization Active NPI Optometrist · Tukwila, WA
NPI 1962561639 · NPPES record last updated Jun 16, 2008
Key facts
- NPI
- 1962561639
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OD00001214 (WA)
- Legal business name
- EDGAR CROCKETT OD PS
- Practice address
- 70 Andover Park W
Tukwila, WA 98188 - Phone
- (206) 439-7588
- Fax
- (206) 241-6857
- NPI assigned
- Dec 8, 2006
- Organization subpart
- No
Authorized official
- Name
- Edgar P Crockett, OD
- Title
- Manager
- Phone
- (206) 439-7588
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OD00001214 | WA | Yes |
Addresses
Primary practice location
70 Andover Park W
Tukwila, WA 98188
Mailing address
70 Andover Park W
Tukwila, WA 98188
Phone (206) 439-7588
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021384 | Medicaid | WA |
Other providers in Tukwila, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 16, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.