=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083353320
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAMERON ROBERT DAMMEYER OD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2022
-----------------------------------------------------
Last Update Date | 06/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10300 SILVERDALE WAY NW
-----------------------------------------------------
City | SILVERDALE
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98383-7990
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-633-2933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7171 WINDFLOWER PL NW
-----------------------------------------------------
City | SEABECK
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98380-9596
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-689-3875
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OD61313030
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------