Provider Demographics
NPI:1194707315
Name:CROWELL, GARY DEAN (OD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DEAN
Last Name:CROWELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1341 NE HIGHWAY 99W
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-2722
Mailing Address - Country:US
Mailing Address - Phone:503-472-0644
Mailing Address - Fax:503-472-0427
Practice Address - Street 1:1341 NE HIGHWAY 99W
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-2722
Practice Address - Country:US
Practice Address - Phone:503-472-0644
Practice Address - Fax:503-472-0427
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1224T152W00000X
OR1224ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR178004Medicaid
ORR131251Medicare PIN
OR5965830001Medicare NSC
ORT93209Medicare UPIN
ORR131250Medicare Oscar/Certification