Provider Demographics
NPI:1619911245
Name:FUJIWARA, CRAIG ISAMU (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ISAMU
Last Name:FUJIWARA
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 1:1910 SW 18TH AVE
Mailing Address - Street 2:#26
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-6006
Mailing Address - Country:US
Mailing Address - Phone:503-222-5199
Mailing Address - Fax:
Practice Address - Street 1:11800 SE 82ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97086-7711
Practice Address - Country:US
Practice Address - Phone:503-786-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2512 ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist