Basic Information
| Provider Information | |||||||||
| NPI: | 1194953596 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROSSWELL | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | GRANDERSON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1920 PICKENS ST. | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037793070 | ||||||||
| FaxNumber: | 8037717639 | ||||||||
| Practice Location | |||||||||
| Address1: | 1920 PICKENS ST. | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037793070 | ||||||||
| FaxNumber: | 8037717639 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2009 | ||||||||
| LastUpdateDate: | 08/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | LL31756 | SC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.