Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | T02882 | MO |
NPI | 1003971946 |
---|---|
Provider Name | Elizabeth Crowley |
First Address | San Antonio, TX 78213-1370 |
Second Address | Independence, MO 64057 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U02325 | (02) | MO |