Healthcare Provider Details

I. General information

NPI: 1205111036
Provider Name (Legal Business Name): DR MARK B CRAFFORD ASSOC P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

296 CONSTITUTION DR
VIRGINIA BEACH VA
23462-6704
US

IV. Provider business mailing address

296 CONSTITUTION DR
VIRGINIA BEACH VA
23462-6704
US

V. Phone/Fax

Practice location:
  • Phone: 757-671-8957
  • Fax: 757-671-8982
Mailing address:
  • Phone: 757-671-8957
  • Fax: 757-671-8982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: MR. MARK B CRAFFORD
Title or Position: OFFICE MANAGER
Credential: O.D.
Phone: 757-671-8957