Provider Demographics
NPI:1073505657
Name:CROOKS, CHESTER THOMAS
Entity Type:Individual
Prefix:
First Name:CHESTER
Middle Name:THOMAS
Last Name:CROOKS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PERIMETER PARK S
Mailing Address - Street 2:SUITE 155 SO
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2327
Mailing Address - Country:US
Mailing Address - Phone:205-968-9196
Mailing Address - Fax:205-968-9198
Practice Address - Street 1:3099 ALLISON BONNETT MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HUEYTOWN
Practice Address - State:AL
Practice Address - Zip Code:35023-2261
Practice Address - Country:US
Practice Address - Phone:205-491-8755
Practice Address - Fax:205-491-8757
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS427TA024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T69168Medicare UPIN
AL30622Medicare ID - Type Unspecified