Individual
KENNETH GRAHAM CRUTCHFIELD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
310 KENT ST, JEFFERSON CITY, MO 65109-6107
(573) 659-7363
Mailing address
310 KENT ST, JEFFERSON CITY, MO 65109-6107
(573) 659-7363
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
04962T
TX
152W00000X
Optometrist
0601001489
VA
152W00000X
Optometrist
Primary
T02684
MO
Other
Enumeration date
05/28/2007
Last updated
07/08/2007
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