Provider Demographics
NPI:1710028725
Name:CRUM, WILLIAM A (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:CRUM
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 1:5965 W RAY RD STE 26
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-1892
Mailing Address - Country:US
Mailing Address - Phone:480-940-3222
Mailing Address - Fax:480-940-9946
Practice Address - Street 1:5965 W RAY RD STE 26
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-1892
Practice Address - Country:US
Practice Address - Phone:480-940-3222
Practice Address - Fax:480-940-9946
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ1374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ242903Medicaid
AZ117624Medicare PIN
AZ1912193608Medicare Oscar/Certification