Provider Demographics
NPI:1255634481
Name:CRADDOCK OPTOMETRY, PS
Entity type:Organization
Organization Name:CRADDOCK OPTOMETRY, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:CRADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-588-2814
Mailing Address - Street 1:6239 WOODLAWN AVE N
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5716
Mailing Address - Country:US
Mailing Address - Phone:206-588-2814
Mailing Address - Fax:206-432-9751
Practice Address - Street 1:6239 WOODLAWN AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-5716
Practice Address - Country:US
Practice Address - Phone:206-588-2814
Practice Address - Fax:206-432-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty