1164547048 NPI number — DR. KENNETH ROBERT CRAWLEY OD

Table of content: DR. KENNETH ROBERT CRAWLEY OD (NPI 1164547048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164547048 NPI number — DR. KENNETH ROBERT CRAWLEY OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAWLEY
Provider First Name:
KENNETH
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164547048
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 N GRANVILLE AVE STE L4
Provider Second Line Business Mailing Address:
MUNCIE MALL
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47303-1254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-286-5977
Provider Business Mailing Address Fax Number:
765-286-5988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 N GRANVILLE AVE STE L4
Provider Second Line Business Practice Location Address:
MUNCIE MALL
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47303-1254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-286-5977
Provider Business Practice Location Address Fax Number:
765-286-5988
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  18001737 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1737 . This is a "VISION BENEFITS OF AMERIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43106 . This is a "CLARITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 217779 . This is a "CLARITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000269589 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 000000269582 . This is a "BLUECROSS/BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 919893 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 990002951 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 10609 . This is a "DAVIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00083065 . This is a "RAI;ROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 918567 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".




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