Provider Demographics
NPI:1043207665
Name:WOLF, CRAIG S (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:WOLF
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 1:604 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:HEATH
Mailing Address - State:OH
Mailing Address - Zip Code:43056-1213
Mailing Address - Country:US
Mailing Address - Phone:740-522-8444
Mailing Address - Fax:740-522-6493
Practice Address - Street 1:604 S 30TH ST
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1213
Practice Address - Country:US
Practice Address - Phone:740-522-8444
Practice Address - Fax:740-522-6493
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4244/P-128152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0797562Medicaid
OHV05381Medicare UPIN
OHWO0676261Medicare ID - Type Unspecified
OH0797562Medicaid
OH0250840001Medicare NSC