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NPI Code Detail

MEDICARE: DR. LEE H. CRADDOCK O.D.

MEDICARE: DR. LEE H. CRADDOCK O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1205-368-TLA
2152W00000XOptometrist1208-368TLA

General Provider Information

NPI Number : 1487754040
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LEE H. CRADDOCK O.D.
Provider Business Mailing Address
First Line : 973 HWY 90 E
Second Line :
City : MORGAN CITY
State : LA
Zip : 70380-5156
Country : US
Telephone Number : 985-395-7219
Fax Number : 985-395-7723
Provider Business Practice Location Address
First Line : 973 HWY 90 E
Second Line :
City : MORGAN CITY
State : LA
Zip : 70380-5156
Country : US
Telephone Number : 985-395-7219
Fax Number : 985-395-7723
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2006
Last Update Date : 03/15/2012

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