Provider Demographics
NPI:1851473920
Name:CROWLEY, JEFFREY RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RONALD
Last Name:CROWLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:111 STAR ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-4888
Mailing Address - Country:US
Mailing Address - Phone:507-385-8110
Mailing Address - Fax:507-385-8107
Practice Address - Street 1:111 STAR ST
Practice Address - Street 2:SUITE 101
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-4888
Practice Address - Country:US
Practice Address - Phone:507-385-8110
Practice Address - Fax:507-385-8107
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist