=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144489147
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRANMER EYE CENTER, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 06/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 ADELINE PL
-----------------------------------------------------
City | MANSFIELD CENTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06250-1656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-456-8650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 ADELINE PL
-----------------------------------------------------
City | MANSFIELD CENTER
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06250-1656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-456-8650
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KEVIN CRANMER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 860-456-8650
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 044355
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------