Healthcare Provider Details

I. General information

NPI: 1346392248
Provider Name (Legal Business Name): EARL R CROUCH JR MD FACS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4665 SOUTH BLVD
VIRGINIA BEACH VA
23452-1055
US

IV. Provider business mailing address

4665 SOUTH BLVD
VIRGINIA BEACH VA
23452-1055
US

V. Phone/Fax

Practice location:
  • Phone: 757-461-0050
  • Fax: 757-461-4538
Mailing address:
  • Phone: 757-461-0050
  • Fax: 757-461-4538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: EARL R CROUCH JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 757-461-0050