Provider Demographics
NPI:1760465512
Name:COLEMAN, CRAIG ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:ALAN
Last Name:COLEMAN
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 1:5525 SCIOTO DARBY RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1311
Mailing Address - Country:US
Mailing Address - Phone:614-876-6524
Mailing Address - Fax:614-876-6246
Practice Address - Street 1:5525 SCIOTO DARBY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1311
Practice Address - Country:US
Practice Address - Phone:614-876-6524
Practice Address - Fax:614-876-6246
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0778618Medicaid
OHCO0656161Medicare ID - Type Unspecified
OH0778618Medicaid