Provider Demographics
NPI:1740330190
Name:CRUTCHFIELD, MICHAEL C (OD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:C
Last Name:CRUTCHFIELD
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 1:8230 W SAHARA AVE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-8959
Mailing Address - Country:US
Mailing Address - Phone:702-944-2001
Mailing Address - Fax:702-947-0474
Practice Address - Street 1:8230 W SAHARA AVE STE 121
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8930
Practice Address - Country:US
Practice Address - Phone:702-944-2001
Practice Address - Fax:702-947-0474
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVT67179Medicare UPIN
NV002502867Medicaid
NVV34246Medicare PIN
NV410049319OtherRAILROAD MEDICARE
NV4422060001Medicare NSC
NVCC1740OtherBCBS PROVIDER ID