MEDICARE: KIRSTEN CRENSHAW OD

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	11465	TX

General Provider Information

NPI Number	:	1518778679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTEN CRENSHAW OD

Provider Business Mailing Address
First Line	:	1033 CANTERBURY LN
Second Line	:
City	:	FORNEY
State	:	TX
Zip	:	75126-3808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1329 W DAVIS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-2309
Country	:	US
Telephone Number	:	936-441-3939
Fax Number	:

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

Provider Enumeration Date	:	01/17/2025
Last Update Date	:	09/15/2025

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Directions to “ KIRSTEN CRENSHAW OD” Practice Location

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