Individual provider Active NPI

Carolyn Mohedano-Craner, O.D.

  • Optometrist
  • Mount Vernon, NY
National Provider Identifier
1144396128
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
VUT005691 Issued in NY
Practice address
105 Stevens Ave
Suite 203
Mount Vernon, NY 10550-2686
Phone
(914) 668-7442
Fax
(914) 668-4669
NPI assigned
Nov 28, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X VUT005691 NY Primary

Addresses

Primary practice location

105 Stevens Ave
Suite 203
Mount Vernon, NY 10550-2686

Mailing address

162 Colonial Rd
Unit #10
Stamford, CT 06906-1639

Other identifiers 1

IdentifierTypeStateIssuer
01608364MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111227000521 NY Practitioner - Optometry 2264608199 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
State University of New York - State College Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

105 Stevens Ave
Suite 203
Mount Vernon, NY 10550-2682
Phone (914) 668-7442

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
VUT005691NYMDOptometrist
005691NYMDMedical Physician Assistant

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144396128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "162 COLONIAL RD",
            "address_2": "UNIT #10",
            "city": "STAMFORD",
            "state": "CT",
            "postal_code": "069061639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 STEVENS AVE",
            "address_2": "SUITE 203",
            "city": "MOUNT VERNON",
            "state": "NY",
            "postal_code": "105502686",
            "telephone_number": "914-668-7442",
            "fax_number": "914-668-4669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOHEDANO-CRANER",
        "first_name": "CAROLYN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "VUT005691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01608364",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, NY

Sources for this page

Verify at the official NPI Registry.