Provider Demographics
NPI:1629539812
Name:CRAIG R MCNAMARA, OD PC
Entity Type:Organization
Organization Name:CRAIG R MCNAMARA, OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRENDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:VANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MACLAUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-320-8440
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:334-301-4990
Mailing Address - Fax:
Practice Address - Street 1:1717 S COLLEGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832-5870
Practice Address - Country:US
Practice Address - Phone:334-821-6943
Practice Address - Fax:334-832-5870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS461TA293OtherALABAMA OPTOMETRIC ASSOCIATION