Provider Demographics
NPI:1760990568
Name:CRYSTAL S OLIVER OD PLLC
Entity Type:Organization
Organization Name:CRYSTAL S OLIVER OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:S
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-826-1500
Mailing Address - Street 1:1413 N ELM ST STE 102
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2776
Mailing Address - Country:US
Mailing Address - Phone:270-826-1500
Mailing Address - Fax:270-827-0757
Practice Address - Street 1:1413 N ELM ST STE 102
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2776
Practice Address - Country:US
Practice Address - Phone:270-826-1500
Practice Address - Fax:270-827-0757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty