Provider Demographics
NPI:1225005606
Name:EYE DOCTORS LTD PS
Entity type:Organization
Organization Name:EYE DOCTORS LTD PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCCRUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-659-1446
Mailing Address - Street 1:1083 CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4232
Mailing Address - Country:US
Mailing Address - Phone:360-659-1446
Mailing Address - Fax:360-659-7324
Practice Address - Street 1:1083 CEDAR AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4232
Practice Address - Country:US
Practice Address - Phone:360-659-1446
Practice Address - Fax:360-659-7324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-03
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2562205Medicaid
WA2562205Medicaid