Organization
CREVISTON AND PEDERSEN LLC
Active
Other names
Vision Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
LAURIE SHEPPARD (OFFICE MANAGER)
(509) 765-2125
Entity
Organization
Contact information
Practice address
601 S PIONEER WAY, SUITE D, MOSES LAKE, WA 98837-4801
(509) 765-2125
(509) 766-0147
Mailing address
601 S PIONEER WAY, SUITE D, MOSES LAKE, WA 98837-4801
(509) 765-2125
(509) 766-0147
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2001428
—
WA
Enumeration date
03/26/2007
Last updated
11/11/2008
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