Provider Demographics
NPI:1255314274
Name:THEODORE G. CROOK INC.
Entity Type:Organization
Organization Name:THEODORE G. CROOK INC.
Other - Org Name:CAMDEN EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CROOK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:803-424-1142
Mailing Address - Street 1:408 DEKALB ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-4429
Mailing Address - Country:US
Mailing Address - Phone:803-424-1142
Mailing Address - Fax:
Practice Address - Street 1:408 DEKALB ST
Practice Address - Street 2:SUITE C
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-4429
Practice Address - Country:US
Practice Address - Phone:803-424-1142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0413152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9937Medicaid
SCDO4136Medicaid
SCDO4136Medicaid
SCT23898Medicare UPIN
SC4143Medicare PIN
SC0339840002Medicare ID - Type UnspecifiedDURABLE GOODS