Healthcare Provider Details

I. General information

NPI: 1891007282
Provider Name (Legal Business Name): JUSTIN M. CROWE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S LINCOLN AVE
UNION MO
63084-2121
US

IV. Provider business mailing address

507 S LINCOLN AVE
UNION MO
63084-2121
US

V. Phone/Fax

Practice location:
  • Phone: 636-583-3322
  • Fax: 636-583-8328
Mailing address:
  • Phone: 636-583-3322
  • Fax: 636-583-8328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2010020555
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: