Provider Demographics
NPI:1487754040
Name:CRADDOCK, LEE H (OD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:H
Last Name:CRADDOCK
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 1:973 HWY 90 E
Mailing Address - Street 2:
Mailing Address - City:MORGAN CITY
Mailing Address - State:LA
Mailing Address - Zip Code:70380-5156
Mailing Address - Country:US
Mailing Address - Phone:985-395-7219
Mailing Address - Fax:985-395-7723
Practice Address - Street 1:973 HWY 90 E
Practice Address - Street 2:
Practice Address - City:MORGAN CITY
Practice Address - State:LA
Practice Address - Zip Code:70380-5156
Practice Address - Country:US
Practice Address - Phone:985-395-7219
Practice Address - Fax:985-395-7723
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1205-368-T152W00000X
LA1208-368T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist