Individual
CRAIG ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8160 FREEDOM LN NE, SUITE D, LACEY, WA 98516-4753
(360) 455-4425
(360) 455-3200
Mailing address
9321 MILBURN LOOP SE, LACEY, WA 98513-3420
(360) 790-1669
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
226
AK
152W00000X
Optometrist
Primary
MR0424806
WA
152W00000X
Optometrist
OD00003743
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202160317
TRICARE PIN #
AK
01
—
3183314
AETNA HMO PROVIDER #
—
01
—
410048942
RAILROAD MEDICARE PIN #
—
01
—
4536RO
REGENCE BLUE SHIELD PIN
—
01
—
721551995
TRICARE PIN #
WA
01
—
7283193
AETNA PPO PROVIDER #
—
05
—
OD2260
—
AK
01
—
P00327511
MEDICARE RAILROAD CARRIER GROUP # DE9528
WA
Enumeration date
06/13/2006
Last updated
08/14/2008
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