Healthcare Provider Details

I. General information

NPI: 1104810795
Provider Name (Legal Business Name): JOHN WILLIAM CROTTY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 12/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922 ALDEN DR
AUBURN NE
68305-3021
US

IV. Provider business mailing address

922 ALDEN DR
AUBURN NE
68305-3021
US

V. Phone/Fax

Practice location:
  • Phone: 402-274-3218
  • Fax: 402-274-4538
Mailing address:
  • Phone: 402-274-3218
  • Fax: 402-274-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number815
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number815
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: