Individual
JEFFREY L CROMWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1300 N 200 E, SUITE 104, LOGAN, UT 84341-2398
(435) 752-6453
(435) 752-6486
Mailing address
190 SUMMIT DR, SMITHFIELD, UT 84335-1143
(435) 563-5248
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
62492069934
UT
152W00000X
Optometrist
ODP100129
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000055942
MEDICARE PTAN
UT
01
—
1594509
MEDICARE PTAN
ID
05
—
1801902333
—
ID
05
—
1801902333
—
UT
Enumeration date
08/21/2006
Last updated
03/01/2011
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