Provider Demographics
NPI:1497160667
Name:CRAIG PEW O.D., INC
Entity Type:Organization
Organization Name:CRAIG PEW O.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:PEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-575-8590
Mailing Address - Street 1:205 E 1250 N
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2438
Mailing Address - Country:US
Mailing Address - Phone:706-575-8590
Mailing Address - Fax:801-295-7123
Practice Address - Street 1:200 N MARKET PLACE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1752
Practice Address - Country:US
Practice Address - Phone:801-295-7118
Practice Address - Fax:801-295-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7713445-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000073508Medicare UPIN