Provider Demographics
NPI:1720189608
Name:MARLEY, CRAIG MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MATTHEW
Last Name:MARLEY
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 1:7654 MADDEN DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-9425
Mailing Address - Country:US
Mailing Address - Phone:120-846-5658
Mailing Address - Fax:
Practice Address - Street 1:7319 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-6051
Practice Address - Country:US
Practice Address - Phone:120-885-3478
Practice Address - Fax:120-885-3478
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID0-506152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist