Provider Demographics
NPI:1962551002
Name:MCSURDY, CRAIG CHARLES (OD)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:CHARLES
Last Name:MCSURDY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2066 W HENDERSON RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2452
Mailing Address - Country:US
Mailing Address - Phone:614-457-2081
Mailing Address - Fax:614-457-6021
Practice Address - Street 1:2066 W HENDERSON RD
Practice Address - Street 2:SUITE 104
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2452
Practice Address - Country:US
Practice Address - Phone:614-457-2081
Practice Address - Fax:614-457-6021
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4215 T1087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH097583Medicare PIN
OHMC0750484Medicare PIN