Healthcare Provider Details

I. General information

NPI: 1285646398
Provider Name (Legal Business Name): ROBERT WADE CROW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 HEALTH SCIENCES RD
IRVINE CA
92617-3058
US

IV. Provider business mailing address

850 HEALTH SCIENCES RD
IRVINE CA
92617-3058
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-2020
  • Fax:
Mailing address:
  • Phone: 949-824-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number6259385-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA110458
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberA110458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: