Provider Demographics
NPI:1831178862
Name:CROSSNOE, CONSTANCE JOSEPHINE (OD)
Entity type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:JOSEPHINE
Last Name:CROSSNOE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:CONNER
Other - Last Name:CROSSNOE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:5412 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3405
Mailing Address - Country:US
Mailing Address - Phone:806-743-7676
Mailing Address - Fax:806-743-7941
Practice Address - Street 1:1610 5TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79401-2622
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05386TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038322602Medicaid
TX038322602Medicaid
TX8F2652Medicare PIN