Provider Demographics
NPI:1780685156
Name:CRUM, HOWARD E (OD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:E
Last Name:CRUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2465 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-3111
Mailing Address - Country:US
Mailing Address - Phone:859-278-7462
Mailing Address - Fax:859-278-7464
Practice Address - Street 1:2465 NICHOLASVILLE RD STE B
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3111
Practice Address - Country:US
Practice Address - Phone:859-278-7462
Practice Address - Fax:859-278-7464
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0734152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9005403Medicare PIN