Organization
CROCKETT FAMILY VISION CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYAN CROCKETT (OWNER)
(859) 498-4800
Entity
Organization
Contact information
Practice address
25 STERLING WAY STE C, MT STERLING, KY 40353-1174
(859) 498-4800
Mailing address
25 STERLING WAY STE C, MT STERLING, KY 40353-1174
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1342DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000062161
ANTHEM
KY
05
—
77013423
—
KY
Enumeration date
10/26/2009
Last updated
10/26/2009
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