MEDICARE: CAROLYN MOHEDANO-CRANER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	VUT005691	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144396128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN MOHEDANO-CRANER O.D.

Provider Business Mailing Address
First Line	:	162 COLONIAL RD
Second Line	:	UNIT #10
City	:	STAMFORD
State	:	CT
Zip	:	06906-1639
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 STEVENS AVE
Second Line	:	SUITE 203
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2686
Country	:	US
Telephone Number	:	914-668-7442
Fax Number	:	914-668-4669

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	07/08/2007

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