Provider Demographics
NPI:1922189844
Name:BRIMER, CRYSTAL M (OD)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:M
Last Name:BRIMER
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 1:710 MILITARY CUTOFF ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-2382
Mailing Address - Country:US
Mailing Address - Phone:910-447-2020
Mailing Address - Fax:866-984-3914
Practice Address - Street 1:710 MILITARY CUTOFF ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-2382
Practice Address - Country:US
Practice Address - Phone:910-447-2020
Practice Address - Fax:866-984-3914
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1811152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014TCMedicaid
NC2200298OtherUHC ID #
NC014PAOtherBCBS PROVIDER ID
NC89093KFMedicaid
NC014PAOtherBCBS
NCB8413OtherMEDCOST PROVIDER #
NC2741801BMedicare PIN
NC014PAOtherBCBS PROVIDER ID
NC2200298OtherUHC ID #