Provider Demographics
NPI:1831354919
Name:CROOKS, ALICIA PRICE (OD)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:PRICE
Last Name:CROOKS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ALICIA
Other - Middle Name:K
Other - Last Name:PRICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:461 LINTON RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:LA
Mailing Address - Zip Code:71006
Mailing Address - Country:US
Mailing Address - Phone:318-623-1664
Mailing Address - Fax:318-550-3432
Practice Address - Street 1:2536 AIRLINE DRIVE
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111
Practice Address - Country:US
Practice Address - Phone:318-742-9690
Practice Address - Fax:318-747-9492
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1558590T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1558590TOtherLICENSE
LA1368971Medicaid