Individual
THOMAS GEORGE CROFFEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3531 MARY ADER AVE, SUITE B, CHARLESTON, SC 29414-5896
(843) 577-2047
(843) 577-0640
Mailing address
3531 MARY ADER AVE, SUITE B, CHARLESTON, SC 29414-5896
(843) 577-2047
(843) 577-0640
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
515
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
406580115
RAILROAD MEDICARE ID
SC
05
—
D05153
—
SC
01
—
DA9789
MEDICAID GROUP NUMBER
SC
Enumeration date
12/27/2005
Last updated
07/21/2008
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