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General NPI Number Information
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NPI Number | 1831378843
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Entity Type | Organization
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Legal Business Name | CRUM OPTOMETRIC GROUP, INC
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Dates
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Enumeration Date | 10/25/2007
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Last Update Date | 04/08/2014
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Provider Practice Location Address
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Address Line | 2581 CHINO HILLS PKWY SUITE C
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City | CHINO HILLS
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State | CA
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Zip | 91709-5117
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Country | US
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Telephone | 909-393-8378
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Fax | 909-393-0228
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Provider Business Mailing Address
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Address Line | 2581 CHINO HILLS PKWY SUITE C
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City | CHINO HILLS
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State | CA
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Zip | 91709-5117
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Country | US
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Telephone | 909-393-8378
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Fax | 909-393-0228
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JON M CRUM
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Credential | OD
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Telephone | 909-393-8378
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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 | CA9524T
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License Number State | CA
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