Individual provider Active NPI

Kevin Crawford, OD

  • Optometrist
  • Elizabethtown, KY
National Provider Identifier
1194722819
Registry record updated Jun 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1097DT Issued in KY
Practice address
1705 N Dixie Hwy
Elizabethtown, KY 42701-5506
Phone
(270) 769-2020
Fax
(502) 736-4490
NPI assigned
Jul 7, 2005
Last updated
Jun 14, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1097DT KY Primary
Optometrist 152W00000X 18003162A IN

Addresses

Primary practice location

1705 N Dixie Hwy
Elizabethtown, KY 42701-5506

Mailing address

5855 Reliable Pkwy
Chicago, IL 60686-0001
Phone (502) 955-2020

Other identifiers 1

IdentifierTypeStateIssuer
77010973MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1097KYMDHealth Service Psychologist
18003162AINMDOptometrist
1097DTKYMDOptometrist

Interoperability endpoints

  • Direct secure messaging: kevincrawford@direct.eyecare-partners.com

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276473600000",
    "number": "1194722819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "502-955-2020",
            "fax_number": "502-736-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 N DIXIE HWY",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427015506",
            "telephone_number": "270-769-2020",
            "fax_number": "502-736-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CRAWFORD",
        "first_name": "KEVIN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2010-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1097DT",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003162A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77010973",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elizabethtown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.