Provider Demographics
NPI:1679622492
Name:CROWE, KATHLEEN M (OD)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:CROWE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:BAIDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3 HEMPHILL PL
Mailing Address - Street 2:SUITE 114
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4419
Mailing Address - Country:US
Mailing Address - Phone:518-899-0003
Mailing Address - Fax:518-899-0123
Practice Address - Street 1:3 HEMPHILL PL
Practice Address - Street 2:SUITE 114
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4419
Practice Address - Country:US
Practice Address - Phone:518-899-0003
Practice Address - Fax:518-899-0123
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5427152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400071697OtherMEDICARE PTAN
NYU66071Medicare UPIN