Provider Demographics
NPI:1881738516
Name:BLAIR, CRAIG MATT (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MATT
Last Name:BLAIR
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 1:2012 CALLIE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7520
Mailing Address - Country:US
Mailing Address - Phone:859-384-6112
Mailing Address - Fax:859-384-6500
Practice Address - Street 1:2012 CALLIE WAY STE 101
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-7520
Practice Address - Country:US
Practice Address - Phone:859-384-6112
Practice Address - Fax:859-384-6500
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1667 DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist