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General NPI Number Information
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NPI Number | 1437204815
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Entity Type | Individual
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Provider Name | AMY CRISSMAN HEAD O.D., F.A.A.O.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 31815 SOUTHFIELD RD STE 12
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City | BEVERLY HILLS
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State | MI
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Zip | 48025-5471
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Country | US
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Telephone | 248-220-6438
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Fax |
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Provider Business Mailing Address
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Address Line | 1149 HILL LINE TRL
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48301-2132
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Country | US
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Telephone | 248-225-8161
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 4901003852
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003852
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License Number State | MI
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