Provider Demographics
NPI:1285663583
Name:CRAINE, BRANDON COREY (OD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:COREY
Last Name:CRAINE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 E MATTHEWS AVE
Mailing Address - Street 2:# A
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3145
Mailing Address - Country:US
Mailing Address - Phone:870-561-3224
Mailing Address - Fax:870-561-4370
Practice Address - Street 1:HIGHWAY 18 BYPASS
Practice Address - Street 2:
Practice Address - City:MANILA
Practice Address - State:AR
Practice Address - Zip Code:72442
Practice Address - Country:US
Practice Address - Phone:870-561-3224
Practice Address - Fax:870-561-4370
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR143936722Medicaid
ARU94583Medicare UPIN
AR49778Medicare PIN