Provider Demographics
NPI:1497800122
Name:CAROLYN A CRUVANT, MD, PC
Entity Type:Organization
Organization Name:CAROLYN A CRUVANT, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CRUVANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-796-8680
Mailing Address - Street 1:3006 S MARYLAND PKWY
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-2218
Mailing Address - Country:US
Mailing Address - Phone:702-796-8680
Mailing Address - Fax:702-796-6634
Practice Address - Street 1:3006 S MARYLAND PKWY
Practice Address - Street 2:SUITE 215
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-2218
Practice Address - Country:US
Practice Address - Phone:702-796-8680
Practice Address - Fax:702-796-6634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5853207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5274OtherMEDICAL EYE SERVICES
NV7326OtherBCBS
5844OtherDAVIS VISION
NV002002632Medicaid
579OtherNEVADACARE
9615702OtherGHI
0850014OtherMEDICA
AZ861270Medicaid
NV7326OtherBCBS
579OtherNEVADACARE
5274OtherMEDICAL EYE SERVICES
MD5853AMedicare ID - Type Unspecified