Provider Demographics
NPI:1902929631
Name:MARK A GRANDAS
Entity Type:Organization
Organization Name:MARK A GRANDAS
Other - Org Name:CRUSE EYE CARE SPECIALTIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GRANDAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:717-848-1316
Mailing Address - Street 1:1018 N GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17404-2026
Mailing Address - Country:US
Mailing Address - Phone:717-848-1316
Mailing Address - Fax:
Practice Address - Street 1:1018 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-2026
Practice Address - Country:US
Practice Address - Phone:717-848-1316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01974483Medicaid
PA4940170001Medicare NSC
PA01974483Medicaid