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General NPI Number Information
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NPI Number | 1598490690
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Entity Type | Individual
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Provider Name | JESSICA CRUM OD
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Gender | Female
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Dates
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Enumeration Date | 07/21/2022
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 315 LEONARDWOOD RD
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City | FRANKFORT
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State | KY
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Zip | 40601-6532
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Country | US
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Telephone | 502-223-2314
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Fax | 502-451-8663
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Provider Business Mailing Address
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Address Line | 4000 POPLAR LEVEL RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-1524
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Country | US
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Telephone | 502-813-8923
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Fax | 502-357-7570
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2273DT
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License Number State | KY
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