Provider Demographics
NPI:1790710226
Name:CROWE, LAURA F (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:F
Last Name:CROWE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 STAGE RD
Mailing Address - Street 2:SUITE 144
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2866
Mailing Address - Country:US
Mailing Address - Phone:901-377-9588
Mailing Address - Fax:301-377-9968
Practice Address - Street 1:6600 STAGE RD
Practice Address - Street 2:SUITE 144
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3838
Practice Address - Country:US
Practice Address - Phone:901-377-9588
Practice Address - Fax:301-377-9968
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT1245152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
176841OtherBCBS
TN3597293Medicaid
TN0551690001Medicare NSC
TN3597293Medicare PIN
U08437Medicare UPIN