Provider Demographics
NPI:1417055625
Name:MCNAMARA, CRAIG RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:RICHARD
Last Name:MCNAMARA
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 1:7613 HALCYON FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3495
Mailing Address - Country:US
Mailing Address - Phone:334-271-1894
Mailing Address - Fax:
Practice Address - Street 1:1642 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-6637
Practice Address - Country:US
Practice Address - Phone:334-821-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS461TA293152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT68992Medicare UPIN