Provider Demographics
NPI:1073605457
Name:CRAWFORD, CACHE MCKELL (OD)
Entity Type:Individual
Prefix:DR
First Name:CACHE
Middle Name:MCKELL
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3911 COFFEE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93308-5024
Mailing Address - Country:US
Mailing Address - Phone:661-588-8222
Mailing Address - Fax:661-588-0222
Practice Address - Street 1:3911 COFFEE RD
Practice Address - Street 2:SUITE B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-5024
Practice Address - Country:US
Practice Address - Phone:661-588-8222
Practice Address - Fax:661-588-0222
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13005T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS733ZMedicare PIN
V11502Medicare UPIN