Provider Demographics
NPI:1437153186
Name:MATCH, CRAIG M (OD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:MATCH
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 1:901 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:PA
Mailing Address - Zip Code:17032-8940
Mailing Address - Country:US
Mailing Address - Phone:717-896-3216
Mailing Address - Fax:717-896-3710
Practice Address - Street 1:901 N RIVER RD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:PA
Practice Address - Zip Code:17032-8940
Practice Address - Country:US
Practice Address - Phone:717-896-3216
Practice Address - Fax:717-896-3710
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG000037OtherSTATE LICENSE #
PAOEG000037OtherSTATE LICENSE #
PAT27011Medicare UPIN
0580560001Medicare NSC