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General NPI Number Information
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NPI Number | 1720021330
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Entity Type | Individual
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Provider Name | CRAIG ROUSE
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Gender | Male
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Dates
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Enumeration Date | 06/13/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 8160 FREEDOM LN NE SUITE D
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City | LACEY
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State | WA
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Zip | 98516-4753
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Country | US
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Telephone | 360-455-4425
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Fax | 360-455-3200
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Provider Business Mailing Address
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Address Line | 9321 MILBURN LOOP SE
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City | LACEY
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State | WA
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Zip | 98513-3420
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Country | US
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Telephone | 360-790-1669
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003743
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 226
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | MR0424806
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License Number State | WA
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