Basic Information
| Provider Information | |||||||||
| NPI: | 1316047004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CROLEY | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 THOMPSON POYNTER RD | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407417238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068782012 | ||||||||
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| Practice Location | |||||||||
| Address1: | 110 CONN TER STE 550 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405083206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593235867 | ||||||||
| FaxNumber: | 8593235867 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2006 | ||||||||
| LastUpdateDate: | 09/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1368DT | KY | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.