Provider Demographics
NPI:1144396128
Name:MOHEDANO-CRANER, CAROLYN (OD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:
Last Name:MOHEDANO-CRANER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 COLONIAL RD
Mailing Address - Street 2:UNIT #10
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06906-1639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-668-7442
Practice Address - Fax:914-668-4669
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005691152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01608364Medicaid
NY01608364Medicaid
NYC03801Medicare ID - Type Unspecified