Provider Demographics
NPI:1770571580
Name:STEVEN E. CROUCHER, O.D. & GABRIELLE NITTI, O.D.
Entity type:Organization
Organization Name:STEVEN E. CROUCHER, O.D. & GABRIELLE NITTI, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:973-746-5665
Mailing Address - Street 1:77 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2962
Mailing Address - Country:US
Mailing Address - Phone:973-746-5665
Mailing Address - Fax:973-746-0422
Practice Address - Street 1:77 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2962
Practice Address - Country:US
Practice Address - Phone:973-746-5665
Practice Address - Fax:973-746-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJAO 04024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0244130001Medicare NSC
U25474Medicare UPIN
U42365Medicare UPIN
014075Medicare PIN