Provider Demographics
NPI:1134295033
Name:CRUM, HAROLD H III (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:H
Last Name:CRUM
Suffix:III
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 1:13313 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-3228
Mailing Address - Country:US
Mailing Address - Phone:562-946-1957
Mailing Address - Fax:562-941-6155
Practice Address - Street 1:13313 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-3228
Practice Address - Country:US
Practice Address - Phone:562-946-1957
Practice Address - Fax:562-941-6155
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT6635TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT6635TPAOtherOPTOMETRY LIC
CASD00066350Medicaid