Organization
NICO ROUSE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG FORREST ROUSE (PRESIDENT)
(360) 790-1669
Entity
Organization
Contact information
Practice address
2202 LIGGETT AVENUE, FORT LEWIS, WA 98433-9500
(253) 964-4140
(253) 964-1696
Mailing address
9321 MILBURN LOOP SE, LACEY, WA 98513-3420
(360) 790-1669
(360) 456-1545
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003743
WA
152W00000X
Optometrist
OD00003984
WA
152W00000X
Optometrist
OD00004138
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3183314
AETNA HMO
—
01
—
4536RO
REGENCE BLUE SHIELD
—
01
—
7283193
AETNA PPO
—
01
—
P00327511 DE9528
MEDICARE RAIL ROAD
WA
Enumeration date
09/20/2007
Last updated
04/29/2008
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