Provider Demographics
NPI:1891007282
Name:CROWE, JUSTIN M (OD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:M
Last Name:CROWE
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 1:507 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-2121
Mailing Address - Country:US
Mailing Address - Phone:636-583-3322
Mailing Address - Fax:636-583-8328
Practice Address - Street 1:507 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-2121
Practice Address - Country:US
Practice Address - Phone:636-583-3322
Practice Address - Fax:636-583-8328
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020555152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1891007282Medicaid
MO1891007282Medicaid