Provider Demographics
NPI:1346216173
Name:CRON, LORENA R (OD)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:R
Last Name:CRON
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37060-0189
Mailing Address - Country:US
Mailing Address - Phone:615-274-2102
Mailing Address - Fax:615-274-2106
Practice Address - Street 1:355 SO MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37060-0189
Practice Address - Country:US
Practice Address - Phone:615-274-2102
Practice Address - Fax:615-274-2106
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4041298OtherBLUE CROSS BLUE SHIELD
TN4041298OtherBLUE CROSS BLUE SHIELD
U12557Medicare UPIN
3597682Medicare PIN