Provider Demographics
NPI:1144633439
Name:CRABTREE, DERRICK W (OD)
Entity type:Individual
Prefix:DR
First Name:DERRICK
Middle Name:W
Last Name:CRABTREE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:2441 NW PRAIRIE VIEW RD
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079-7627
Mailing Address - Country:US
Mailing Address - Phone:816-858-2522
Mailing Address - Fax:816-858-2946
Practice Address - Street 1:5430 FREDERICKSBURG RD
Practice Address - Street 2:STE 100
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3539
Practice Address - Country:US
Practice Address - Phone:210-340-1212
Practice Address - Fax:210-525-9617
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618002333152W00000X
TX9048152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist