Provider Demographics
NPI:1649573908
Name:LESLIE E. CRADDOCK, OD, PS
Entity Type:Organization
Organization Name:LESLIE E. CRADDOCK, OD, PS
Other - Org Name:EYES ON THE CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CRADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-836-5352
Mailing Address - Street 1:602 228TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-7241
Mailing Address - Country:US
Mailing Address - Phone:425-836-5352
Mailing Address - Fax:425-898-9880
Practice Address - Street 1:602 228TH AVE NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7241
Practice Address - Country:US
Practice Address - Phone:425-836-5352
Practice Address - Fax:425-898-9880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty