Provider Demographics
NPI:1154593614
Name:EARL DOUGLAS CREW JR OD
Entity type:Organization
Organization Name:EARL DOUGLAS CREW JR OD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CREW
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:229-226-8833
Mailing Address - Street 1:15043 US HIGHWAY 19 SOUTH
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792
Mailing Address - Country:US
Mailing Address - Phone:229-226-8833
Mailing Address - Fax:229-226-2020
Practice Address - Street 1:15043 US HIGHWAY 19 SOUTH
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792
Practice Address - Country:US
Practice Address - Phone:229-226-8833
Practice Address - Fax:229-226-2020
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EARL DOUGLAS CREW JR OD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA901T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty