MEDICARE: DR. JEFFREY R CRABTREE 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	6990T	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	468430ZSWL	OTHER	TX	MEDICARE ID(S) ASSOCIATED WITH A REASSIGNMENT OF BENEFITS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	6990T	OTHER	TX	OPTOMETRIC LICENSE

General Provider Information

NPI Number	:	1861573099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY R CRABTREE O.D.

Provider Business Mailing Address
First Line	:	6921 FOSTER DR
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2818
Country	:	US
Telephone Number	:	817-439-9455
Fax Number	:

Provider Business Practice Location Address
First Line	:	6921 FOSTER DR
Second Line	:
City	:	LAKE WORTH
State	:	TX
Zip	:	76135-2818
Country	:	US
Telephone Number	:	817-439-9455
Fax Number	:

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/07/2023

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