Provider Demographics
NPI:1063844918
Name:CRANDELL, CHELSEA LYNN
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:LYNN
Last Name:CRANDELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 WEST FRYE RD
Mailing Address - Street 2:APT 2084
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224
Mailing Address - Country:US
Mailing Address - Phone:602-396-9150
Mailing Address - Fax:
Practice Address - Street 1:1940 S COUNTRY CLUB DR
Practice Address - Street 2:SUITE 102
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6042
Practice Address - Country:US
Practice Address - Phone:480-834-6367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-02
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist