Provider Demographics
NPI:1104993203
Name:CRAFT, ARNOLD D (OD)
Entity type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:D
Last Name:CRAFT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 GEORGE RUSSELL WAY
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-2655
Mailing Address - Country:US
Mailing Address - Phone:973-688-8145
Mailing Address - Fax:
Practice Address - Street 1:201A MARKET ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-1405
Practice Address - Country:US
Practice Address - Phone:201-796-0030
Practice Address - Fax:201-796-3448
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00467200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4812506Medicaid
NJ533232Medicare ID - Type Unspecified
NJ4812506Medicaid