Individual
DR. AMY CRISSMAN HEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D., F.A.A.O.
Contact information
Practice address
31815 SOUTHFIELD RD STE 12, BEVERLY HILLS, MI 48025-5471
(248) 220-6438
Mailing address
1149 HILL LINE TRL, BLOOMFIELD HILLS, MI 48301-2132
(248) 225-8161
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003852
MI
152WL0500X
Low Vision Rehabilitation Optometrist
4901003852
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
383145055
TAX ID
MI
01
—
900F310020
BCBS PROVIDER CODE
MI
Enumeration date
01/24/2007
Last updated
09/21/2020
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