Healthcare Provider Details

I. General information

NPI: 1295795052
Provider Name (Legal Business Name): JUDY M CRAYTHORN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 PECOS MCLEOD
LAS VEGAS NV
89121-3803
US

IV. Provider business mailing address

3575 PECOS MCLEOD
LAS VEGAS NV
89121-3803
US

V. Phone/Fax

Practice location:
  • Phone: 702-731-2088
  • Fax: 702-734-7836
Mailing address:
  • Phone: 702-731-2088
  • Fax: 702-734-7836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number5468
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number171870-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: