Provider Demographics
NPI:1760674592
Name:CREWS, STANLEY LLOYD (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:LLOYD
Last Name:CREWS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12306 SE MILL PLAIN BLVD
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-6061
Mailing Address - Country:US
Mailing Address - Phone:360-896-8482
Mailing Address - Fax:360-896-6456
Practice Address - Street 1:12306 SE MILL PLAIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-6061
Practice Address - Country:US
Practice Address - Phone:360-896-8482
Practice Address - Fax:360-896-6456
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024816207W00000X
ORMD16861207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR110145Medicare PIN