Provider Demographics
NPI:1740324367
Name:CROUCH, KEVIN L (OD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:CROUCH
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 1:5118 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3520
Mailing Address - Country:US
Mailing Address - Phone:605-339-1939
Mailing Address - Fax:605-330-0252
Practice Address - Street 1:5118 W 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3520
Practice Address - Country:US
Practice Address - Phone:605-339-1939
Practice Address - Fax:605-330-0252
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD526152W00000X
IA02029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9231588OtherDAKOTACARE
SD0004141OtherBCBS
SD1250550001OtherCIGNA DMERC
SD9201502Medicaid
SDCV12701OtherSPECTERA
SD5118OtherVSP
SD30391OtherSIOUX VALLEY HEALTH PLAN
SD5214OtherDAVIS VISION
SD5118OtherVSP
SD0004141OtherBCBS