Provider Demographics
NPI:1588791578
Name:CRAWFORD, JAMES R (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:CRAWFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 S GREENLEAF ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5708
Mailing Address - Country:US
Mailing Address - Phone:847-244-1657
Mailing Address - Fax:847-244-1657
Practice Address - Street 1:310 S GREENLEAF ST
Practice Address - Street 2:SUITE 209
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5708
Practice Address - Country:US
Practice Address - Phone:847-244-1657
Practice Address - Fax:847-244-1657
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04007910152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL04915265OtherBLUE CROSS - BLUE SHIELD
IL04007910Medicaid
IL759490Medicare PIN
IL04915265OtherBLUE CROSS - BLUE SHIELD