MEDICARE: DR. EDWARD EVANS CROWE 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	0618000490	VA

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
2	075525	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1740287176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD EVANS CROWE O.D.

Provider Business Mailing Address
First Line	:	PO BOX 795
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-0795
Country	:	US
Telephone Number	:	434-575-7360
Fax Number	:	434-575-7618

Provider Business Practice Location Address
First Line	:	1328 SEYMOUR DR
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-3914
Country	:	US
Telephone Number	:	434-575-7360
Fax Number	:	434-575-7618

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	05/20/2008

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