Provider Demographics
NPI:1679155204
Name:DR. RENA R. CRON
Entity Type:Organization
Organization Name:DR. RENA R. CRON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:615-274-2102
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37060-0189
Mailing Address - Country:US
Mailing Address - Phone:615-274-2102
Mailing Address - Fax:615-274-2106
Practice Address - Street 1:355 S MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37060-4510
Practice Address - Country:US
Practice Address - Phone:615-274-2102
Practice Address - Fax:615-274-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3596683Medicaid