Provider Demographics
NPI:1518059088
Name:CROWN, J R (OD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:R
Last Name:CROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:R
Other - Last Name:CROWN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:21126 SE 28TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7417
Mailing Address - Country:US
Mailing Address - Phone:503-806-1382
Mailing Address - Fax:
Practice Address - Street 1:2201 W DOLARWAY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-8228
Practice Address - Country:US
Practice Address - Phone:509-925-1000
Practice Address - Fax:509-925-2474
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist