Provider Demographics
NPI:1376627539
Name:SULTAN, CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:SULTAN
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 1:1328 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2525
Mailing Address - Country:US
Mailing Address - Phone:707-254-2020
Mailing Address - Fax:707-254-2036
Practice Address - Street 1:1328 PEARL ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2525
Practice Address - Country:US
Practice Address - Phone:707-254-2020
Practice Address - Fax:707-254-2036
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6569T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0006691Medicaid
CAT 10356Medicare UPIN
CASD0065690Medicare PIN