Provider Demographics
NPI:1295795052
Name:CRAYTHORN, JUDY M (MD)
Entity type:Individual
Prefix:DR
First Name:JUDY
Middle Name:M
Last Name:CRAYTHORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 PECOS MCLEOD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3803
Mailing Address - Country:US
Mailing Address - Phone:702-731-2088
Mailing Address - Fax:702-734-7836
Practice Address - Street 1:3575 PECOS MCLEOD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-3803
Practice Address - Country:US
Practice Address - Phone:702-731-2088
Practice Address - Fax:702-734-7836
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5468207W00000X
UT171870-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002787Medicaid
1218020001OtherNAS-DME
5010OtherMEDICAL EYE SERVICES
5468OtherBLUE CROSS BLUE SHIELD
P00454782OtherPALMETTO RAILROAD
NV002002787Medicaid