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General NPI Number Information
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NPI Number | 1720827744
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Entity Type | Individual
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Provider Name | JESSICA LOUISE CRAIL LDO
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Gender | Female
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Dates
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Enumeration Date | 05/20/2024
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Last Update Date | 05/20/2024
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Provider Practice Location Address
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Address Line | 7001 BRIDGEPORT WAY W
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City | LAKEWOOD
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State | WA
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Zip | 98499-8099
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Country | US
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Telephone | 253-512-0965
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Fax | 253-512-0967
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Provider Business Mailing Address
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Address Line | 2627 CHAMPION CT SW
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City | OLYMPIA
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State | WA
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Zip | 98512-9012
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Country | US
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Telephone | 509-630-4884
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 61236619
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License Number State | WA
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