Individual
NATHAN A CROUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3101 FIELDS SOUTH DR, CHAMPAIGN, IL 61822-3743
(217) 366-1250
Mailing address
101 W UNIVERSITY AVE, CHAMPAIGN, IL 61820-3981
(217) 366-1250
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046009653
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046009653
—
IL
01
—
05832113
BLUE CROSS
IL
Enumeration date
06/20/2005
Last updated
01/06/2022
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