Basic Information
| Provider Information | |||||||||
| NPI: | 1922754563 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CRAINE | ||||||||
| FirstName: | HUGHIE | ||||||||
| MiddleName: | CARLTON | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | RPSGT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 885 SW 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | WILLISTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326962419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789191704 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1601 SW ARCHER RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326081135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523761611 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/22/2022 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 156F00000X | 15841 | Y | Eye and Vision Services Providers | Technician/Technologist |
No ID Information.