Provider Demographics
NPI:1932194297
Name:CRAIG, MARIO JILBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:JILBERT
Last Name:CRAIG
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 1:651 N WELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1635
Mailing Address - Country:US
Mailing Address - Phone:631-226-2020
Mailing Address - Fax:631-226-7371
Practice Address - Street 1:651 N WELLWOOD AVE
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-1635
Practice Address - Country:US
Practice Address - Phone:631-226-2020
Practice Address - Fax:631-226-7371
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006374152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY169422OtherVYTRA
NY7313502OtherAETNA
NYP3139396OtherOXFORD
NY3399516OtherAETNA
NYP82818751OtherMULTIPLAN
NYP3139396OtherOXFORD
NY3399516OtherAETNA