Active NPI
Nucrown, LLC
Doing business as Crown Optical
- Optometrist
- Bridgeton, MO
National Provider Identifier
1730586629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T02999
- Legal business name
- NUCROWN, LLC
- Doing business as
- Crown Optical
- Practice address
- 3454 McKelvey Rd
Bridgeton, MO 63044-2533 - Phone
- (314) 291-7717
- Fax
- (314) 291-7372
- NPI assigned
- Nov 21, 2014
- Last updated
- Apr 21, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Charles D. Matthews
- Title
- President
- Phone
- (618) 462-9818
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | T02999 | MO | Primary |
Addresses
Primary practice location
3454 McKelvey Rd
Bridgeton, MO 63044-2533
Mailing address
3454 McKelvey Rd
Bridgeton, MO 63044-2533
Phone (314) 291-7717
Other names 1
- Crown Optical
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150428000453 | MO | DME Supplier - Physician - Optometrist | 1456256346 | Practice locations: Bridgeton, MO |
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Tax ID family
- Crown Optical
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
Locations
3454 McKelvey Rd
Bridgeton, MO 63044
Phone (314) 291-7717
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416528000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1492732800000",
"number": "1730586629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3454 MCKELVEY RD",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442533",
"telephone_number": "314-291-7717",
"fax_number": "314-291-7372"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3454 MCKELVEY RD",
"city": "BRIDGETON",
"state": "MO",
"postal_code": "630442533",
"telephone_number": "314-291-7717",
"fax_number": "314-291-7372"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NUCROWN, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-11-21",
"last_updated": "2017-04-21",
"status": "A",
"authorized_official_last_name": "MATTHEWS",
"authorized_official_first_name": "CHARLES",
"authorized_official_middle_name": "D.",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "618-462-9818"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T02999",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Crown Optical",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bridgeton, MO
- Northwest Anesthesia, LTD.
- Northwest Infectious Disease Services LLC
- Northwest Internal Medicine Specialists
- Northwest Otolaryngology, Inc (Northwest Otolaryngology)
- Francis Ntimba, M.D.
- Rachel Elizabeth O'Bannon, MS CCC-SLP CBIS
- Kelly O'Brien, DPT
- Laura Elizabeth O'Neal
- Jack Roh Oak, MD
- Occupational Health Centers of Kansas PA (dba, Concentra Medical Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.