Provider Demographics
NPI:1124024294
Name:CRAIG, MARGIT (OD)
Entity Type:Individual
Prefix:
First Name:MARGIT
Middle Name:
Last Name:CRAIG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1877 E DAILY DR
Mailing Address - Street 2:STE D-1
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-6205
Mailing Address - Country:US
Mailing Address - Phone:805-987-5300
Mailing Address - Fax:805-987-5330
Practice Address - Street 1:4353 PARK TERRACE DR
Practice Address - Street 2:STE 150
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4631
Practice Address - Country:US
Practice Address - Phone:805-987-5300
Practice Address - Fax:805-987-5330
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004020414152W00000X
CAOPT 14355 TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO318344421Medicaid
MO926326438Medicare ID - Type Unspecified