Provider Demographics
NPI:1558593863
Name:CRUM, AMANDA D (OD)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:D
Last Name:CRUM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11225 HURON LN STE 200A
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1861
Mailing Address - Country:US
Mailing Address - Phone:501-268-5808
Mailing Address - Fax:501-305-3370
Practice Address - Street 1:1225 W. BEEBECAPPS EXPY
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143
Practice Address - Country:US
Practice Address - Phone:501-268-5808
Practice Address - Fax:501-305-3370
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AR2637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR181917722Medicaid
AR4T048G337Medicare PIN