Provider Demographics
NPI:1093086977
Name:LEE H. CRADDOCK O.D. APOC
Entity Type:Organization
Organization Name:LEE H. CRADDOCK O.D. APOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-395-7219
Mailing Address - Street 1:973 HIGHWAY 90 E
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-5156
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:973 HIGHWAY 90 E
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-5156
Practice Address - Country:US
Practice Address - Phone:985-395-7219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEE H CRADDOCK O.D. APOC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-24
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1208-368T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty