Organization
NICO ROUSE CORPORATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG FORREST ROUSE O.D. (PRESIDENT)
(360) 790-1669
Entity
Organization
Contact information
Practice address
5800 WESTOVER AVE, ELMENDORF AFB, AK 99506-1603
(907) 753-7515
(907) 753-7585
Mailing address
9321 MILBURN LOOP SE, LACEY, WA 98513-3420
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
226
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3183314
AETNA HMO
—
01
—
7283193
AETNA PPO
—
01
—
DE9528
MEDICARE RAILROAD GROUP #
—
05
—
OD2260
—
AK
01
—
P00327511
MEDICARE RAILROAD
—
Enumeration date
11/20/2006
Last updated
08/22/2020
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