Clyde E. Croom, OD, PA

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

791 Issued in NC

Legal business name

CLYDE E. CROOM, OD, PA

Practice address

11 Enterprise St
Raleigh, NC 27607-7323

Phone

(919) 834-6206

NPI assigned

Aug 13, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Clyde E Croom, OD

Title

President

Phone

(919) 834-6206

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1218585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1669628442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 ENTERPRISE ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077323",
            "telephone_number": "919-834-6206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 ENTERPRISE ST",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276077323",
            "telephone_number": "919-834-6206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLYDE E. CROOM, OD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-13",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "CROOM",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "919-834-6206",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "NC",
            "license": "791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian Cloninger
• Tracey S Cloninger, PA-C
• Kristie Reynolds Clontz, FNP-C
• Charles A Cloutier, M.D.
• Christina Clyburn, FNLP
• CMC Transportation
• CNC / Access, Inc.
• CNC Access Inc
• CNC Access Inc
• CNC Access Inc

• Customized Equipment (DME) in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Customized Equipment (DME) in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2008; 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.