Healthcare Provider Details

I. General information

NPI: 1619172368
Provider Name (Legal Business Name): CRABTREE AND MERRIMAN DCTRS OF OPTOMETRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 TRANSCRAFT DR
ANNA IL
62906-2114
US

IV. Provider business mailing address

1508 SIOUX DR
MARION IL
62959-5200
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-3777
  • Fax: 618-833-3777
Mailing address:
  • Phone: 618-993-8787
  • Fax: 618-997-6547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number046-007399
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN KELLER
Title or Position: MANAGER
Credential:
Phone: 618-993-8787