Provider Demographics
NPI:1487717708
Name:CRANSTON EYE ASSOCIATES INC.
Entity type:Organization
Organization Name:CRANSTON EYE ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:SURDUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1401-942-4087
Mailing Address - Street 1:1013 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-5134
Mailing Address - Country:US
Mailing Address - Phone:401-942-4087
Mailing Address - Fax:401-942-3342
Practice Address - Street 1:1013 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-5134
Practice Address - Country:US
Practice Address - Phone:401-942-4087
Practice Address - Fax:401-942-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTA 00356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI092470OtherMEDICARE P-TAN
RI7002604Medicaid
RI092470OtherMEDICARE P-TAN
RI7002604Medicaid
RI419009742Medicare PIN