Provider Demographics
NPI:1639217417
Name:CRUTCHMER, ALLISON LEA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:LEA
Last Name:CRUTCHMER
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 1:10557 E HIGHWAY 51
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74014-2308
Mailing Address - Country:US
Mailing Address - Phone:918-279-8830
Mailing Address - Fax:866-871-7350
Practice Address - Street 1:10557 E HIGHWAY 51
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74014-2308
Practice Address - Country:US
Practice Address - Phone:918-279-8830
Practice Address - Fax:866-871-7350
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3052152W00000X
OK2805152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-03406OtherMEDICA
MN811T9KLOtherBLUE CROSS BLUE SHIELD
MNMN3052OtherEYEMED
MN696455000OtherMN CARE
MNHP70338OtherHEALTHPARTNERS