Provider Demographics
NPI:1659322980
Name:CRAIG, WILLIAM BOYCE (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BOYCE
Last Name:CRAIG
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 1:6704 OLD CANTON RD
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1225
Mailing Address - Country:US
Mailing Address - Phone:601-957-9292
Mailing Address - Fax:601-957-7585
Practice Address - Street 1:1185 HART ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-4805
Practice Address - Country:US
Practice Address - Phone:601-859-3464
Practice Address - Fax:601-859-9003
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00089240Medicaid
MS00089240Medicaid
MS410000308Medicare ID - Type Unspecified