Provider Demographics
NPI:1023178274
Name:CROWLEY, JENNIFER L (OD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:CROWLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:L
Other - Last Name:MCBURNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8084 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8024
Mailing Address - Country:US
Mailing Address - Phone:614-864-3937
Mailing Address - Fax:614-864-9008
Practice Address - Street 1:8084 E BROAD ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8024
Practice Address - Country:US
Practice Address - Phone:614-864-3937
Practice Address - Fax:614-864-9008
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4476152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0938329Medicaid
OH0752503Medicare ID - Type Unspecified
OHU46408Medicare UPIN
OH5917120001Medicare NSC