Organization
EDGAR CROCKETT OD PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDGAR P CROCKETT OD (MANAGER)
(206) 439-7588
Entity
Organization
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
12/08/2006
Last updated
06/16/2008
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