Provider Demographics
NPI:1093750481
Name:NORTH CASCADE EYE ASSOCIATES PS
Entity Type:Organization
Organization Name:NORTH CASCADE EYE ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANNETTE
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-416-6735
Mailing Address - Street 1:2100 LITTLE MOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98274-8752
Mailing Address - Country:US
Mailing Address - Phone:360-416-6735
Mailing Address - Fax:360-424-6954
Practice Address - Street 1:2100 LITTLE MOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98274-8752
Practice Address - Country:US
Practice Address - Phone:360-416-6735
Practice Address - Fax:360-424-6954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7301229Medicaid
WA7301229Medicaid