Provider Demographics
NPI:1659364453
Name:CROTTY, ROBERT THEUS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THEUS
Last Name:CROTTY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 PARLIAMENT DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2717
Mailing Address - Country:US
Mailing Address - Phone:318-448-4488
Mailing Address - Fax:318-448-9731
Practice Address - Street 1:4110 PARLIAMENT DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2717
Practice Address - Country:US
Practice Address - Phone:318-448-4488
Practice Address - Fax:318-448-9731
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA991006T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1355151Medicaid
T19524Medicare UPIN
LA48236Medicare ID - Type Unspecified