Provider Demographics
NPI:1427112044
Name:CRANFORD, NORVEL BARRY (OD)
Entity type:Individual
Prefix:DR
First Name:NORVEL
Middle Name:BARRY
Last Name:CRANFORD
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 1:4403 LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4311
Mailing Address - Country:US
Mailing Address - Phone:337-474-5789
Mailing Address - Fax:337-474-5730
Practice Address - Street 1:4403 LAKE STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4311
Practice Address - Country:US
Practice Address - Phone:337-474-5789
Practice Address - Fax:337-474-5730
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1542784Medicaid
T19571Medicare UPIN
LA1542784Medicaid