Organization
2020 FAMILY EYECARE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CACHE MCKELL CRAWFORD OD (OWNER/PRESIDENT)
(661) 331-6011
Entity
Organization
Contact information
Practice address
301 S 4TH AVE, #C-2, POCATELLO, ID 83201-6462
(208) 637-0841
Mailing address
301 S 4TH AVE, #C-2, POCATELLO, ID 83201-6462
(208) 637-0841
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100247
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ODP-100247
LICENSE NUMBER
ID
Enumeration date
03/07/2012
Last updated
03/07/2012
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