MEDICARE: DR. MARK BAKER CRAFFORD O.D.

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	1382	VA

General Provider Information

NPI Number	:	1669597118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BAKER CRAFFORD O.D.

Provider Business Mailing Address
First Line	:	2710 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7615
Country	:	US
Telephone Number	:	757-390-2020
Fax Number	:	757-229-7964

Provider Business Practice Location Address
First Line	:	2710 VIRGINIA BEACH BLVD
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-7615
Country	:	US
Telephone Number	:	757-390-2020
Fax Number	:	757-229-7964

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	04/03/2013

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