Healthcare Provider Details

I. General information

NPI: 1013909894
Provider Name (Legal Business Name): GARY J CRAPANZANO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7630 BROADVIEW RD
PARMA OH
44134-6745
US

IV. Provider business mailing address

7630 BROADVIEW RD
PARMA OH
44134-6745
US

V. Phone/Fax

Practice location:
  • Phone: 216-642-5500
  • Fax: 216-642-9829
Mailing address:
  • Phone: 216-642-5500
  • Fax: 216-642-9829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3529
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: