Basic Information
Provider Information | |||||||||
NPI: | 1578637419 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | CRANDALL | ||||||||
FirstName: | MELANIE | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MCMAHON | ||||||||
OtherFirstName: | MELANIE | ||||||||
OtherMiddleName: | CRANDALL | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | O.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 1012 N OCEAN BLVD | ||||||||
Address2: |   | ||||||||
City: | POMPANO BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 330624056 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9547880721 | ||||||||
FaxNumber: | 9547882321 | ||||||||
Practice Location | |||||||||
Address1: | 3200 S UNIVERSITY DR | ||||||||
Address2: | NSU THE EYE INSTITUTE SUITE 1402 | ||||||||
City: | DAVIE | ||||||||
State: | FL | ||||||||
PostalCode: | 333282018 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9542621402 | ||||||||
FaxNumber: | 9542621818 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/20/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC1346 | FL | Y |   | Eye and Vision Services Providers | Optometrist |   |
No ID Information.