Basic Information
| Provider Information | |||||||||
| NPI: | 1427098078 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAFT | ||||||||
| FirstName: | KATY | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 449 | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457500449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403744500 | ||||||||
| FaxNumber: | 7403745887 | ||||||||
| Practice Location | |||||||||
| Address1: | 210 N 7TH ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MARIETTA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457502244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7403765590 | ||||||||
| FaxNumber: | 7403765591 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2006 | ||||||||
| LastUpdateDate: | 10/13/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 5617 | OH | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 77901981 | 05 | OH | MEDICAID | 7100058270 | 05 | KY | MEDICAID | 77902757 | 05 | OH | MEDICAID | 2912987 | 05 | OH | MEDICAID | P01692640 | 01 | OH | RAILROAD MEDICARE - MHCPI | OTHER | 77901999 | 05 | OH | MEDICAID |