Craig M. Declark, O.D.,P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-007272 Issued in IL

Legal business name

CRAIG M. DECLARK, O.D.,P.C.

Practice address

6336 W Gunnison St
Chicago, IL 60630-2954

Phone

(773) 763-4666

Fax

(773) 763-4967

NPI assigned

Mar 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Craig Matthew Declark, O.D.NPI 1033101993

Title

President

Phone

(773) 763-4666

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Craig Matthew Declark, O.D.

  • Optometrist
  • Chicago, IL
  • NPI 1033101993
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211155200000",
    "number": "1295855385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6336 W GUNNISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302954",
            "telephone_number": "773-763-4666",
            "fax_number": "773-763-4967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6336 W GUNNISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606302954",
            "telephone_number": "773-763-4666",
            "fax_number": "773-763-4967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAIG M. DECLARK, O.D.,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2008-05-19",
        "status": "A",
        "authorized_official_last_name": "DECLARK",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-763-4666",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-007272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Craft-Otterbacher, DNP, FNP-C
• Joshua F Craft, MD
• Kelsey Craft, MSW
• Crafted Care Counseling, PLLC
• Craig C. McCall, Psy.D., P.C.
• Craig W. Millard, D.D.S., P.C.
• Brooke Craig, SLP
• Caroline Craig
• Cassidy Murphy Craig, MD
• Gina Niagara Craig

• Optometrist in Chicago, IL
• Providers in Chicago, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.