Healthcare Provider Details

I. General information

NPI: 1962409896
Provider Name (Legal Business Name): VALERIE JEAN CRANDALL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: VALERIE CRANDALL MOORE M.D.

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 W SUGARLAND HWY
CLEWISTON FL
33440-2700
US

IV. Provider business mailing address

PO BOX 162264
ALTAMONTE SPRINGS FL
32716-2264
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2020
  • Fax:
Mailing address:
  • Phone: 941-792-2020
  • Fax: 239-275-6178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME34980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: