MEDICARE: DR. HOWARD E CRUM 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	KY0734	KY

General Provider Information

NPI Number	:	1780685156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HOWARD E CRUM OD

Provider Business Mailing Address
First Line	:	2465 NICHOLASVILLE RD
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3111
Country	:	US
Telephone Number	:	859-278-7462
Fax Number	:	859-278-7464

Provider Business Practice Location Address
First Line	:	2465 NICHOLASVILLE RD STE B
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40503-3111
Country	:	US
Telephone Number	:	859-278-7462
Fax Number	:	859-278-7464

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/11/2009

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