Provider Demographics
NPI:1013110196
Name:CRAIN EYE CLINIC
Entity type:Organization
Organization Name:CRAIN EYE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
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 1:470 SPRING STREET STE 200
Practice Address - Street 2:
Practice Address - City:FRIDAY HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98250
Practice Address - Country:US
Practice Address - Phone:360-378-2637
Practice Address - Fax:360-378-8947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CRAIN EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-07
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1106780001Medicare NSC