Provider Demographics
NPI:1245348242
Name:PRUITT, CRAIG BERNARD (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:BERNARD
Last Name:PRUITT
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 1:246 SAINT MATTHEWS LN
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1323
Mailing Address - Country:US
Mailing Address - Phone:864-574-0311
Mailing Address - Fax:
Practice Address - Street 1:VISION PLUS 1955 E MAIN ST
Practice Address - Street 2:1955 EAST MAIN ST. SUITE C.
Practice Address - City:DUNCAN
Practice Address - State:SC
Practice Address - Zip Code:29334
Practice Address - Country:US
Practice Address - Phone:864-433-9555
Practice Address - Fax:864-433-9523
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9780Medicaid
SCU84403Medicare UPIN
SCU844030281Medicare ID - Type Unspecified