Provider Demographics
NPI:1760660476
Name:BRIAN J CRAIN OD
Entity Type:Organization
Organization Name:BRIAN J CRAIN OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-833-2767
Mailing Address - Street 1:921 HARVEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-4294
Mailing Address - Country:US
Mailing Address - Phone:253-833-2767
Mailing Address - Fax:253-939-2781
Practice Address - Street 1:921 HARVEY RD STE A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-4294
Practice Address - Country:US
Practice Address - Phone:253-833-2767
Practice Address - Fax:253-939-2781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1213TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034908Medicaid
WAT01571Medicare UPIN
WA2034908Medicaid