Provider Demographics
NPI:1710021910
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:
Authorized Official - Last Name:CROWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-416-6735
Mailing Address - Street 1:2131 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-4301
Mailing Address - Country:US
Mailing Address - Phone:360-416-6735
Mailing Address - Fax:360-856-1206
Practice Address - Street 1:2131 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-4301
Practice Address - Country:US
Practice Address - Phone:360-416-6735
Practice Address - Fax:360-856-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
S0375OtherRAILROAD MEDICARE
WAGAB32883Medicare ID - Type UnspecifiedMEDICARE GROUP #
WA5026560001Medicare NSC
S0375OtherRAILROAD MEDICARE