Provider Demographics
NPI:1760444095
Name:CRAIG R. GREEN, O.D. & ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CRAIG R. GREEN, O.D. & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPARTMENT
Authorized Official - Prefix:
Authorized Official - First Name:MARTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-286-5022
Mailing Address - Street 1:260 EAST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:OH
Mailing Address - Zip Code:45640
Mailing Address - Country:US
Mailing Address - Phone:740-286-5022
Mailing Address - Fax:740-286-7000
Practice Address - Street 1:260 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640
Practice Address - Country:US
Practice Address - Phone:740-286-5022
Practice Address - Fax:740-286-7000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0219230Medicaid
OH0457400001OtherADMINISTAR
OHDR9320211Medicare ID - Type Unspecified