Provider Demographics
NPI:1558380964
Name:CRANE, WILLIAM GRACE JR (DO, FACS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:GRACE
Last Name:CRANE
Suffix:JR
Gender:M
Credentials:DO, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 STATE ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-9407
Mailing Address - Country:US
Mailing Address - Phone:315-788-6070
Mailing Address - Fax:315-788-1950
Practice Address - Street 1:1815 STATE ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9407
Practice Address - Country:US
Practice Address - Phone:315-788-6070
Practice Address - Fax:315-788-1950
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010508L207W00000X
WI53660-021207W00000X
KYTP921207W00000X
NY190088207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1208424OtherUNITED HEALTH
PA0017553330002Medicaid
KY61-1208424OtherBLUEGRASS FAMILY HEALTH
PA2191752OtherAETNA
KY61-1208424OtherCHA
KYP01023135OtherMEDICARE RAILROAD
PA028196Medicare ID - Type Unspecified
KYP01023135OtherMEDICARE RAILROAD