Provider Demographics
NPI:1972175735
Name:DR CRYSTAL EDISON OD & ASSOCIATES
Entity Type:Organization
Organization Name:DR CRYSTAL EDISON OD & ASSOCIATES
Other - Org Name:DR. CRYSTAL EDISON, O.D. & ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EDISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-852-1984
Mailing Address - Street 1:8700 NE VANCOUVER MALL DR STE 232
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6418
Mailing Address - Country:US
Mailing Address - Phone:360-882-9355
Mailing Address - Fax:
Practice Address - Street 1:8700 NE VANCOUVER MALL DR STE 232
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6418
Practice Address - Country:US
Practice Address - Phone:360-882-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty