Provider Demographics
NPI:1962665273
Name:CROUCH, LISA GAIL (OD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:GAIL
Last Name:CROUCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:10 000 EMMETT F LOWRY EXPY 1480
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-1478
Mailing Address - Country:US
Mailing Address - Phone:409-986-2155
Mailing Address - Fax:409-986-5425
Practice Address - Street 1:10 000 EMMETT F LOWRY EXPY 1480
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-1478
Practice Address - Country:US
Practice Address - Phone:409-986-2155
Practice Address - Fax:409-986-5425
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4627T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist