Provider Demographics
NPI:1821142332
Name:ECKROTH, CRAIG T (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:T
Last Name:ECKROTH
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 1:1111 W VICTORY WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CRAIG
Mailing Address - State:CO
Mailing Address - Zip Code:81625-2950
Mailing Address - Country:US
Mailing Address - Phone:970-824-3488
Mailing Address - Fax:970-824-8132
Practice Address - Street 1:1111 W VICTORY WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:CRAIG
Practice Address - State:CO
Practice Address - Zip Code:81625-2950
Practice Address - Country:US
Practice Address - Phone:970-824-3488
Practice Address - Fax:970-824-8132
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1589152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO410041337OtherPALMETTO RR MEDICARE
CO08015893Medicaid
CO410041337OtherPALMETTO RR MEDICARE
COU47184Medicare UPIN
COCD6228Medicare PIN