Healthcare Provider Details

I. General information

NPI: 1528060746
Provider Name (Legal Business Name): CRAIG A MERRILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 OAK PARK BLVD STE 201
PISMO BEACH CA
93449-3402
US

IV. Provider business mailing address

3855 BROAD STREET STE B
SAN LUIS OBISPO CA
93401
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-6640
  • Fax: 805-473-5873
Mailing address:
  • Phone: 805-545-7881
  • Fax: 805-548-8785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG81899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: