Provider Demographics
NPI:1730208752
Name:DR. KENNETH CRAWFORD, O.D. INC.
Entity type:Organization
Organization Name:DR. KENNETH CRAWFORD, O.D. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-755-7775
Mailing Address - Street 1:7793 JOAN DR
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3682
Mailing Address - Country:US
Mailing Address - Phone:513-755-7775
Mailing Address - Fax:513-755-7773
Practice Address - Street 1:7793 JOAN DR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3682
Practice Address - Country:US
Practice Address - Phone:513-755-7775
Practice Address - Fax:513-755-7773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4333152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201062OtherUNITEDHEALTHCARE
OHNVAOther360406
0726142OtherMEDICARE
OH09761OtherSPECTERA
OH000000016109OtherANTHEM
OH5931OtherHUMANA
OH35575OtherDAVIS VISION
OH09761OtherSPECTERA
1264700001Medicare NSC