Provider Demographics
NPI:1033277140
Name:NU-CROWN, LLC
Entity Type:Organization
Organization Name:NU-CROWN, LLC
Other - Org Name:CROWN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:D
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-462-9818
Mailing Address - Street 1:211 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6220
Mailing Address - Country:US
Mailing Address - Phone:800-407-2696
Mailing Address - Fax:800-432-6004
Practice Address - Street 1:361 WINDING WOODS CTR
Practice Address - Street 2:SUITE 8
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-4170
Practice Address - Country:US
Practice Address - Phone:636-281-5367
Practice Address - Fax:800-432-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14075OtherSPECTERA
14075OtherSPECTERA
MO990001722Medicare PIN