MEDICARE: DONOVAN L CROUCH O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1470	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255315644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONOVAN L CROUCH O.D.

Provider Business Mailing Address
First Line	:	701 WINTHROP CIR
Second Line	:
City	:	STORM LAKE
State	:	IA
Zip	:	50588-2747
Country	:	US
Telephone Number	:	712-732-2456
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 ONTARIO ST
Second Line	:
City	:	STORM LAKE
State	:	IA
Zip	:	50588-1845
Country	:	US
Telephone Number	:	712-732-3233
Fax Number	:	712-732-1866

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/09/2007

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