Provider Demographics
NPI:1427098078
Name:CRAFT, KATY M (OD)
Entity type:Individual
Prefix:MS
First Name:KATY
Middle Name:M
Last Name:CRAFT
Suffix:
Gender:F
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:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:210 N 7TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2244
Practice Address - Country:US
Practice Address - Phone:740-376-5590
Practice Address - Fax:740-376-5591
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH77901981Medicaid
KY7100058270Medicaid
OH77902757Medicaid
OH2912987Medicaid
OHP01692640OtherRAILROAD MEDICARE - MHCPI
OH77901999Medicaid
OH2912987Medicaid
OH9231582Medicare PIN
OH4193273Medicare PIN
OH77902757Medicaid
OHH462680Medicare PIN
OH4193274Medicare PIN
OH4193272Medicare PIN
OH77901981Medicaid
OHP00687429Medicare PIN