Provider Demographics
NPI:1366612988
Name:JULIAN ANTHONY CROWDER, OD
Entity type:Organization
Organization Name:JULIAN ANTHONY CROWDER, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CROWDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-665-1577
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-0399
Mailing Address - Country:US
Mailing Address - Phone:828-665-1577
Mailing Address - Fax:828-667-5061
Practice Address - Street 1:1431 SMOKEY PARK HWY
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-0399
Practice Address - Country:US
Practice Address - Phone:828-665-1577
Practice Address - Fax:828-667-5061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC963152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09197OtherBCBS OF NC
NC8909197Medicaid
NC41005094OtherMCR RAILROAD
NC1062700001Medicare NSC
NC246302Medicare PIN
NC09197OtherBCBS OF NC