Provider Demographics
NPI:1205111036
Name:DR MARK B CRAFFORD ASSOC P C
Entity type:Organization
Organization Name:DR MARK B CRAFFORD ASSOC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-671-8957
Mailing Address - Street 1:296 CONSTITUTION DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6704
Mailing Address - Country:US
Mailing Address - Phone:757-671-8957
Mailing Address - Fax:757-671-8982
Practice Address - Street 1:296 CONSTITUTION DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-6704
Practice Address - Country:US
Practice Address - Phone:757-671-8957
Practice Address - Fax:757-671-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-12
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty