Provider Demographics
NPI:1346238896
Name:CRAFTON, CATHERAN ALICE (OD)
Entity type:Individual
Prefix:DR
First Name:CATHERAN
Middle Name:ALICE
Last Name:CRAFTON
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 1:210 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-1047
Mailing Address - Country:US
Mailing Address - Phone:765-778-7524
Mailing Address - Fax:
Practice Address - Street 1:210 E WATER ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-1047
Practice Address - Country:US
Practice Address - Phone:765-778-7524
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001704A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T69285Medicare UPIN
503940Medicare ID - Type Unspecified