# CHARLENE CROCKETT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1720379316
- **Gender:** F
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | 191905 | CA | Yes |
| 207W00000X | Ophthalmology Physician | 75772 | GA | — |
| 207W00000X | Ophthalmology Physician | MD459666 | PA | — |
| 207W00000X | Ophthalmology Physician | P9827 | TX | — |

## Other

- **Enumeration date:** 04/29/2011
- **Last updated:** 12/18/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 349043503 | — | TX |
| 05 | — | 349043504 | — | TX |
| 05 | — | 349043505 | — | TX |