Provider Demographics
NPI:1154511152
Name:CRAWFORD, ADAM (OD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
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 1:301 NORTHLAKE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1718
Mailing Address - Country:US
Mailing Address - Phone:601-707-5255
Mailing Address - Fax:
Practice Address - Street 1:301 NORTHLAKE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1718
Practice Address - Country:US
Practice Address - Phone:601-707-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS789152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08576764Medicaid