Provider Demographics
NPI:1811086127
Name:MEHLHOFF, CRAIG D (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:D
Last Name:MEHLHOFF
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:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-0093
Mailing Address - Country:US
Mailing Address - Phone:360-533-1880
Mailing Address - Fax:360-533-1886
Practice Address - Street 1:301 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-3933
Practice Address - Country:US
Practice Address - Phone:360-533-1880
Practice Address - Fax:360-533-1886
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA27402OtherL & I PROV. #
WA0803129OtherBLUECROSS
WA1019536Medicaid
WA410040935OtherRR MEDICARE
WAME 9095OtherREGENCE
WA410040935OtherRR MEDICARE
WA27402OtherL & I PROV. #