Provider Demographics
NPI:1417039306
Name:CROFT, GEORGE M (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:CROFT
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 1:2273 PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-4112
Mailing Address - Country:US
Mailing Address - Phone:801-485-1061
Mailing Address - Fax:
Practice Address - Street 1:1353 S STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-7701
Practice Address - Country:US
Practice Address - Phone:801-225-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1112479934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist