Provider Demographics
NPI:1578637419
Name:CRANDALL, MELANIE A (OD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:A
Last Name:CRANDALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MELANIE
Other - Middle Name:CRANDALL
Other - Last Name:MCMAHON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1012 N OCEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-4056
Mailing Address - Country:US
Mailing Address - Phone:954-788-0721
Mailing Address - Fax:954-788-2321
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:NSU THE EYE INSTITUTE SUITE 1402
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1402
Practice Address - Fax:954-262-1818
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE7711Medicare ID - Type Unspecified
FLT42502Medicare UPIN