Provider Demographics
NPI:1427137496
Name:SCHEFFEL, CRAIG (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:SCHEFFEL
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 1:17 LAKEWOOD CENTER MALL
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2417
Mailing Address - Country:US
Mailing Address - Phone:562-633-6443
Mailing Address - Fax:562-633-6939
Practice Address - Street 1:17 LAKEWOOD CENTER MALL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2417
Practice Address - Country:US
Practice Address - Phone:562-633-6443
Practice Address - Fax:562-633-6939
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5938T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD004180Medicaid
CA0861035Medicaid
CAWY125Medicare ID - Type UnspecifiedCORP. GROUP PROVIDER #
CAWOP5938 AMedicare ID - Type UnspecifiedPPIN #
CA0861035Medicaid