Healthcare Provider Details

I. General information

NPI: 1316047004
Provider Name (Legal Business Name): DEBRA S CROLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CONN TER STE 550
LEXINGTON KY
40508-3206
US

IV. Provider business mailing address

130 THOMPSON POYNTER RD SUITE 1
LONDON KY
40741-7238
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5867
  • Fax: 859-323-5867
Mailing address:
  • Phone: 606-878-2012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1368DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: