Provider Demographics
NPI:1285747956
Name:CROTHERS, ELLEN PEARMAN (OD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:PEARMAN
Last Name:CROTHERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13343 N US HIGHWAY 183
Mailing Address - Street 2:STE 260
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-7160
Mailing Address - Country:US
Mailing Address - Phone:512-569-8886
Mailing Address - Fax:
Practice Address - Street 1:13343 N HIGHWAY 183
Practice Address - Street 2:STE 260
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-7158
Practice Address - Country:US
Practice Address - Phone:512-258-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6206 TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6206-TGOther6206 TG
TX81246QOtherBCBS NUMBER
TXMC 1074917OtherDEA NUMBER
TX8D2919Medicare ID - Type Unspecified
TX81246QOtherBCBS NUMBER