Provider Demographics
NPI:1750302857
Name:CRANDON, ELIZABETH JANE (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JANE
Last Name:CRANDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1019 MASSACHUSETTS ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66044-2923
Mailing Address - Country:US
Mailing Address - Phone:785-843-3844
Mailing Address - Fax:785-331-2496
Practice Address - Street 1:1019 MASSACHUSETTS ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66044-2923
Practice Address - Country:US
Practice Address - Phone:785-843-3844
Practice Address - Fax:785-331-2496
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KST91165Medicare UPIN
KS049810Medicare PIN
KS0409160001Medicare NSC