Provider Demographics
NPI:1821499906
Name:SCIBAL, CRAIG (OD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SCIBAL
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 1:1174 TURLINGTON AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LELAND
Mailing Address - State:NC
Mailing Address - Zip Code:28451-6011
Mailing Address - Country:US
Mailing Address - Phone:910-498-1116
Mailing Address - Fax:910-408-1117
Practice Address - Street 1:1174 TURLINGTON AVE UNIT 104
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:NC
Practice Address - Zip Code:28451-6026
Practice Address - Country:US
Practice Address - Phone:910-408-1116
Practice Address - Fax:910-408-1117
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist