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NPI Code Detail

MEDICARE: MS. NICHOLE RACHELLE CRANE O.D.

MEDICARE: MS. NICHOLE RACHELLE CRANE 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
1152W00000XOptometrist18003303AIN

General Provider Information

NPI Number : 1326186354
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. NICHOLE RACHELLE CRANE O.D.
Provider Business Mailing Address
First Line : 3505 WILBUR RD
Second Line :
City : MARTINSVILLE
State : IN
Zip : 46151-6826
Country : US
Telephone Number : 765-349-0603
Fax Number : 765-349-0603
Provider Business Practice Location Address
First Line : 4200 S EAST ST
Second Line : SUITE D3
City : INDIANAPOLIS
State : IN
Zip : 46227-1534
Country : US
Telephone Number : 317-781-1061
Fax Number : 317-781-1067
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 07/08/2007

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