Healthcare Provider Details

I. General information

NPI: 1124168232
Provider Name (Legal Business Name): DOUGLAS E CRAMER ABOC, NCLC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 WILSON AVE NW SUITE G
GRAND RAPIDS MI
49534-7986
US

IV. Provider business mailing address

511 WILSON AVE NW SUITE G
GRAND RAPIDS MI
49534-7986
US

V. Phone/Fax

Practice location:
  • Phone: 616-301-8663
  • Fax: 616-301-2987
Mailing address:
  • Phone: 616-301-8663
  • Fax: 616-301-2987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: