MEDICARE: CRAIG F WILLOTH OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	002863	NY

General Provider Information

NPI Number	:	1336174747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRAIG F WILLOTH OD

Provider Business Mailing Address
First Line	:	100 KINGS HWY S
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14617-5504
Country	:	US
Telephone Number	:	585-544-6680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1338 E RIDGE RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2018
Country	:	US
Telephone Number	:	585-544-6680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/30/2019

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