Provider Demographics
NPI:1114222148
Name:JOSHUA CROWDER, O.D. PC
Entity Type:Organization
Organization Name:JOSHUA CROWDER, O.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:423-899-2020
Mailing Address - Street 1:7329 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2627
Mailing Address - Country:US
Mailing Address - Phone:423-899-2020
Mailing Address - Fax:423-899-3388
Practice Address - Street 1:7329 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2627
Practice Address - Country:US
Practice Address - Phone:423-899-2020
Practice Address - Fax:423-899-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-23
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2816152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103G416812Medicaid
TN103G416812Medicaid
TN103G416812Medicare PIN