Provider Demographics
NPI:1437344157
Name:CROWLEY, JERRILYN ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:JERRILYN
Middle Name:ANN
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3041 CHAMPION CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-3111
Mailing Address - Country:US
Mailing Address - Phone:325-944-0165
Mailing Address - Fax:
Practice Address - Street 1:5749 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-5643
Practice Address - Country:US
Practice Address - Phone:325-223-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX3772152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist