MEDICARE: EARL R CROUCH JR MD FACS PC

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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1346392248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EARL R CROUCH JR MD FACS PC

Provider Business Mailing Address
First Line	:	4665 SOUTH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1055
Country	:	US
Telephone Number	:	757-461-0050
Fax Number	:	757-461-4538

Provider Business Practice Location Address
First Line	:	4665 SOUTH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1055
Country	:	US
Telephone Number	:	757-461-0050
Fax Number	:	757-461-4538

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EARL R CROUCH JR.
Credential	:	MD
Telephone Number	:	757-461-0050

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	06/11/2019

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