Provider Demographics
NPI:1053834192
Name:CROSBY, WHITNEY (OD)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MOUNTAINSIDE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:PA
Mailing Address - Zip Code:19560-1331
Mailing Address - Country:US
Mailing Address - Phone:814-598-9695
Mailing Address - Fax:
Practice Address - Street 1:264 UPLAND SQ DR
Practice Address - Street 2:
Practice Address - City:POTTSTOWN
Practice Address - State:PA
Practice Address - Zip Code:19464-9434
Practice Address - Country:US
Practice Address - Phone:814-598-9695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist