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General NPI Number Information
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NPI Number | 1497800122
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Entity Type | Organization
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Legal Business Name | CAROLYN A CRUVANT, MD, PC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 06/16/2010
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Provider Practice Location Address
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Address Line | 3006 S MARYLAND PKWY SUITE 215
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City | LAS VEGAS
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State | NV
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Zip | 89109-2218
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Country | US
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Telephone | 702-796-8680
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Fax | 702-796-6634
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Provider Business Mailing Address
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Address Line | 3006 S MARYLAND PKWY SUITE 215
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City | LAS VEGAS
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State | NV
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Zip | 89109-2218
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Country | US
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Telephone | 702-796-8680
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Fax | 702-796-6634
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CAROLYN A CRUVANT
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Credential | M.D.
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Telephone | 702-796-8680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 5853
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License Number State | NV
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