Provider Demographics
NPI:1811037872
Name:CRAIG, SCOTT ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLEN
Last Name:CRAIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2020 FULLERTON AVE APT 51
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-7120
Mailing Address - Country:US
Mailing Address - Phone:949-645-8823
Mailing Address - Fax:
Practice Address - Street 1:234 E 17TH ST
Practice Address - Street 2:SUITE 110
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3825
Practice Address - Country:US
Practice Address - Phone:949-548-1631
Practice Address - Fax:949-548-6430
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12252 TPL152W00000X
DCOP1000127152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist