Individual
MRS. MARY MELITA CRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
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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