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General NPI Number Information
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NPI Number | 1720127798
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Entity Type | Organization
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Legal Business Name | GARY CROWELL OD PC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 06/17/2008
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Provider Practice Location Address
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Address Line | 1291 N HWY 99 W
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City | MCMINNVILLE
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State | OR
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Zip | 97128
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Country | US
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Telephone | 503-472-0644
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Fax | 503-472-0427
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Provider Business Mailing Address
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Address Line | 1291 N HWY 99 W
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City | MCMINNVILLE
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State | OR
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Zip | 97128
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Country | US
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Telephone | 503-472-0644
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Fax | 503-472-0427
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Authorized Official
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Title or Position | CEO
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Name | DR. GARY CROWELL
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Credential | OD
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Telephone | 503-472-0644
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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 | 1224T
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License Number State | OR
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