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NPI Code Detail

MEDICARE: CONSTANCE JOSEPHINE CROSSNOE O.D.

MEDICARE: CONSTANCE JOSEPHINE CROSSNOE 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
1152W00000XOptometrist05386TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1831178862
Entity Type Code : Individual
Provider Name (Legal Business Name) : CONSTANCE JOSEPHINE CROSSNOE O.D.
Provider Business Mailing Address
First Line : 5412 28TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79407-3405
Country : US
Telephone Number : 806-743-7676
Fax Number : 806-743-7941
Provider Business Practice Location Address
First Line : 1610 5TH ST
Second Line :
City : LUBBOCK
State : TX
Zip : 79401-2622
Country : US
Telephone Number : 806-765-2611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2006
Last Update Date : 01/24/2024

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Directions to “ CONSTANCE JOSEPHINE CROSSNOE O.D.” Practice Location

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