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General NPI Number Information
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NPI Number | 1609916964
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Entity Type | Individual
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Provider Name | RONALD VERDEN CRAIG O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 234 E 17TH ST SUITE 110
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City | COSTA MESA
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State | CA
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Zip | 92627-3825
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Country | US
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Telephone | 949-548-1631
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Fax | 949-548-6430
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Provider Business Mailing Address
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Address Line | 2455 SANTA ANA AVE
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City | COSTA MESA
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State | CA
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Zip | 92627-1448
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Country | US
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Telephone | 949-642-1286
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Fax | 949-548-6430
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4151TPL
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License Number State | CA
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