Provider Demographics
NPI:1659302735
Name:CRIGLER, AMY AJAX (OD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:AJAX
Last Name:CRIGLER
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 1:6 PROFESSIONAL PLZ
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-1901
Mailing Address - Country:US
Mailing Address - Phone:662-323-3330
Mailing Address - Fax:662-323-3880
Practice Address - Street 1:6 PROFESSIONAL PLZ
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-3330
Practice Address - Fax:662-323-3880
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880137Medicaid
MST20861Medicare UPIN
MS410000210Medicare ID - Type Unspecified
MS410000210Medicare PIN
MS1427262450Medicare NSC