Provider Demographics
NPI:1316952963
Name:DACALES, CRAIG S (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:S
Last Name:DACALES
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 1:14386 NEWBERN LOOP
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-1478
Mailing Address - Country:US
Mailing Address - Phone:571-216-6419
Mailing Address - Fax:
Practice Address - Street 1:700 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3828
Practice Address - Country:US
Practice Address - Phone:540-216-0816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000631152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009206302Medicaid
VA090943OtherANTHEM
VA009206302Medicaid
VA090943OtherANTHEM