Provider Demographics
NPI:1841630555
Name:CREVISTON, DANIEL EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWARD
Last Name:CREVISTON
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 1:601 S PIONEER WAY STE G
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-1837
Mailing Address - Country:US
Mailing Address - Phone:509-766-2125
Mailing Address - Fax:509-766-0147
Practice Address - Street 1:601 S PIONEER WAY STE G
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1837
Practice Address - Country:US
Practice Address - Phone:509-766-2125
Practice Address - Fax:509-766-0147
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60394191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist