Provider Demographics
NPI:1750456463
Name:ASHCRAFT, HAROLD T (OD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:T
Last Name:ASHCRAFT
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 1:8111 HANDLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3321
Mailing Address - Country:US
Mailing Address - Phone:310-216-1085
Mailing Address - Fax:310-670-2856
Practice Address - Street 1:8735 LA TIJERA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3906
Practice Address - Country:US
Practice Address - Phone:310-670-4411
Practice Address - Fax:310-670-2856
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV216152W00000X
CAOPT7928152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD003160Medicaid
CAT70237Medicare UPIN
CAWY124Medicare ID - Type UnspecifiedGROUP MEDICARE NUMBER