Provider Demographics
NPI:1932388543
Name:JOHN W CROFTS MD PLLC
Entity Type:Organization
Organization Name:JOHN W CROFTS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CROFTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-343-8100
Mailing Address - Street 1:150 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-2113
Mailing Address - Country:US
Mailing Address - Phone:585-343-8100
Mailing Address - Fax:585-815-4302
Practice Address - Street 1:150 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-2113
Practice Address - Country:US
Practice Address - Phone:585-343-8100
Practice Address - Fax:585-815-4302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182112207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01193493Medicaid
NYDC6227OtherPALMETTO GBA PIN
NYDC6227OtherPALMETTO GBA PIN
NYRA5271Medicare PIN
NYB49400Medicare UPIN