Organization
CRAIG M. DECLARK, O.D.,P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG MATTHEW DECLARK O.D. (PRESIDENT)
(773) 763-4666
Entity
Organization
Contact information
Practice address
6336 W GUNNISON ST, CHICAGO, IL 60630-2954
(773) 763-4666
(773) 763-4967
Mailing address
6336 W GUNNISON ST, CHICAGO, IL 60630-2954
(773) 763-4666
(773) 763-4967
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-007272
IL
Other
Enumeration date
03/30/2007
Last updated
05/19/2008
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