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: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 EVANS AVE
FORT MYERS FL
33901-9310
US

IV. Provider business mailing address

PO BOX 11407
BIRMINGHAM AL
35246-8575
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-2020
  • Fax:
Mailing address:
  • Phone: 864-359-1308
  • Fax: 239-496-3939

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: