Individual
JERAD CROSWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
46314 TIMINE WAY, PENDLETON, OR 97801-9417
(541) 966-9830
Mailing address
46314 TIMINE WAY, PENDLETON, OR 97801-9417
(541) 966-9830
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ATI4639
OR
Other
Enumeration date
07/27/2022
Last updated
07/27/2022
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