Provider Demographics
NPI:1588632509
Name:MCCRUM, JAMES M (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:MCCRUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001007152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2562205Medicaid
WA0797000001Medicare NSC
WA2562205Medicaid
WA115103603Medicare PIN