Provider Demographics
NPI:1669597118
Name:CRAFFORD, MARK BAKER (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BAKER
Last Name:CRAFFORD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2710 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7615
Mailing Address - Country:US
Mailing Address - Phone:757-390-2020
Mailing Address - Fax:757-229-7964
Practice Address - Street 1:2710 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7615
Practice Address - Country:US
Practice Address - Phone:757-390-2020
Practice Address - Fax:757-229-7964
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1382152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist