Provider Demographics
NPI:1336378686
Name:SMARGIASSO, CRAIG A (OD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
Last Name:SMARGIASSO
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 1:220 S CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-8805
Mailing Address - Country:US
Mailing Address - Phone:330-348-0269
Mailing Address - Fax:330-348-0794
Practice Address - Street 1:220 S CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-8805
Practice Address - Country:US
Practice Address - Phone:330-348-0269
Practice Address - Fax:330-348-0794
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5897152W00000X
PAOEG002253152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3007561Medicaid