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Individual

DONALD W CRUDEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
2803 CHARLES ST, ROCKFORD, IL 61108-1610
(815) 398-3224
(815) 398-3244
Mailing address
2803 CHARLES ST, ROCKFORD, IL 61108-1610
(815) 398-3224
(815) 398-3244

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
466109
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
250810
MEDICARE PROVIDER NUMBER
IL
Enumeration date
07/31/2006
Last updated
09/09/2008
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