Individual
EDGAR P CROCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
70 ANDOVER PARK W, TUKWILA, WA 98188
(206) 439-7588
(206) 241-6857
Mailing address
70 ANDOVER PARK W, TUKWILA, WA 98188
(206) 439-7588
(206) 241-6857
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00001214
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2021384
—
WA
Enumeration date
12/06/2006
Last updated
07/08/2007
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