Provider Demographics
NPI:1689609851
Name:CRAWFORD, MICHAEL JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JAY
Last Name:CRAWFORD
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 1:2540 WOODVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:43619-1444
Mailing Address - Country:US
Mailing Address - Phone:419-693-0484
Mailing Address - Fax:419-693-2042
Practice Address - Street 1:2540 WOODVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:OH
Practice Address - Zip Code:43619-1444
Practice Address - Country:US
Practice Address - Phone:419-693-0484
Practice Address - Fax:419-693-2042
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3604152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH360944OtherNVA
OH03064OtherPARAMOUNT HEALTHCARE
OH0489449Medicaid
OH580001308Medicare ID - Type UnspecifiedPALMETTO GBA (RAILROAD)
OHCR0501841Medicare ID - Type Unspecified
OH0263410002Medicare NSC
OH03064OtherPARAMOUNT HEALTHCARE
OHT47356Medicare UPIN