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General NPI Number Information
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NPI Number | 1609072263
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Entity Type | Organization
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Legal Business Name | CRABTREE FAMILY OPTOMETRY
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 1508 SIOUX DR
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City | MARION
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State | IL
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Zip | 62959-5209
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Country | US
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Telephone | 618-993-8787
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Fax | 618-997-6547
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Provider Business Mailing Address
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Address Line | 1508 SIOUX DR
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City | MARION
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State | IL
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Zip | 62959-5209
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Country | US
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Telephone | 618-993-8787
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Fax | 618-997-6547
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Authorized Official
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Title or Position | DOCTOR OF OPTOMETRY/ OWNER/ PARTNER
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Name | TREVOR RAY CRABTREE
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Credential | O.D.
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Telephone | 618-993-8787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 046-008310
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License Number State | IL
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