Provider Demographics
NPI:1891889135
Name:CRANDALL, JAMES DAVID (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:CRANDALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2493
Mailing Address - Country:US
Mailing Address - Phone:828-258-1586
Mailing Address - Fax:828-258-6161
Practice Address - Street 1:8 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2493
Practice Address - Country:US
Practice Address - Phone:828-258-1586
Practice Address - Fax:828-258-6161
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39590207W00000X
NC200701661207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64112873Medicaid
KY64112873Medicaid
NC0224210001Medicare NSC
NC2074830Medicare PIN