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Individual

MRS. MARY MELITA CRUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
OPTICIAN

Contact information

Practice address
11266 W FLORISSANT AVE, FLORISSANT, MO 63033-6741
(314) 838-3539
(314) 838-0633
Mailing address
11266 W FLORISSANT AVE, FLORISSANT, MO 63033-6741
(314) 838-3539
(314) 838-0633

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
B0057567A
MO

Other

Enumeration date
09/11/2007
Last updated
05/23/2008
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