Provider Demographics
NPI:1033178041
Name:VERSIL, CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:VERSIL
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 1:6000 W ATLANTIC BLVD
Mailing Address - Street 2:#3
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5132
Mailing Address - Country:US
Mailing Address - Phone:954-977-9500
Mailing Address - Fax:954-977-9500
Practice Address - Street 1:6000 W ATLANTIC BLVD
Practice Address - Street 2:#3
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-5132
Practice Address - Country:US
Practice Address - Phone:954-977-9500
Practice Address - Fax:954-977-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0641410001OtherDMERC
FL078379000Medicaid
FL0641410001OtherDMERC