MEDICARE: DR. MICHAEL C CRUTCHFIELD 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	181	NV

General Provider Information

NPI Number	:	1740330190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL C CRUTCHFIELD O.D.

Provider Business Mailing Address
First Line	:	8230 W SAHARA AVE
Second Line	:	SUITE 121
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8959
Country	:	US
Telephone Number	:	702-944-2001
Fax Number	:	702-947-0474

Provider Business Practice Location Address
First Line	:	8230 W SAHARA AVE STE 121
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-8930
Country	:	US
Telephone Number	:	702-944-2001
Fax Number	:	702-947-0474

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	12/30/2016

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