Provider Demographics
NPI:1629629407
Name:CRAVIN, MATTHEW JOSHUA (LDO, ABOC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:JOSHUA
Last Name:CRAVIN
Suffix:
Gender:M
Credentials:LDO, ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 SEABOARD ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-9627
Mailing Address - Country:US
Mailing Address - Phone:843-839-2233
Mailing Address - Fax:843-839-0137
Practice Address - Street 1:350 SEABOARD ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-9627
Practice Address - Country:US
Practice Address - Phone:843-839-2233
Practice Address - Fax:843-839-0137
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1069156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician