Provider Demographics
NPI:1558703223
Name:CROTTY, RUSSELL JAMES (OD)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:JAMES
Last Name:CROTTY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:922 ALDEN DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NE
Mailing Address - Zip Code:68305-3021
Mailing Address - Country:US
Mailing Address - Phone:402-274-3218
Mailing Address - Fax:402-274-4538
Practice Address - Street 1:922 ALDEN DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NE
Practice Address - Zip Code:68305-3021
Practice Address - Country:US
Practice Address - Phone:402-274-3218
Practice Address - Fax:402-274-4538
Is Sole Proprietor?:No
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1399152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy