Provider Demographics
NPI:1346392248
Name:EARL R CROUCH JR MD FACS PC
Entity Type:Organization
Organization Name:EARL R CROUCH JR MD FACS PC
Other - Org Name:VIRGINIA PEDIATRIC EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EARL
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:757-461-0050
Mailing Address - Street 1:4665 SOUTH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1055
Mailing Address - Country:US
Mailing Address - Phone:757-461-0050
Mailing Address - Fax:757-461-4538
Practice Address - Street 1:4665 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1055
Practice Address - Country:US
Practice Address - Phone:757-461-0050
Practice Address - Fax:757-461-4538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00W009E02Medicare PIN
00W009E01Medicare PIN
181930950Medicare PIN
C09141Medicare PIN