Provider Demographics
NPI:1962474718
Name:CRAIN, BRIAN J (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:CRAIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 HARVEY RD
Mailing Address - Street 2:STE A
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
Practice Address - Street 2:STE A
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1213TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034908Medicaid
WA410008354OtherPALMETTO GBA - RAILROAD MEDICARE
WA2034908Medicaid
WAG000101093Medicare PIN
T01571Medicare UPIN