Healthcare Provider Details

I. General information

NPI: 1326186354
Provider Name (Legal Business Name): NICHOLE RACHELLE CRANE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 S EAST ST SUITE D3
INDIANAPOLIS IN
46227-1534
US

IV. Provider business mailing address

3505 WILBUR RD
MARTINSVILLE IN
46151-6826
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-1061
  • Fax: 317-781-1067
Mailing address:
  • Phone: 765-349-0603
  • Fax: 765-349-0603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003303A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: