Provider Demographics
NPI:1104973866
Name:CROWLEY, STEPHEN JOSEPH I (OD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOSEPH
Last Name:CROWLEY
Suffix:I
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 1:8973 BERYL CREEK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-5251
Mailing Address - Country:US
Mailing Address - Phone:916-684-7939
Mailing Address - Fax:
Practice Address - Street 1:8973 BERYL CREEK WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5251
Practice Address - Country:US
Practice Address - Phone:916-684-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6194T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10257Medicare UPIN