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NPI Code Detail

MEDICARE: MR. DOUGLAS E CRAMER ABOC, NCLC

MEDICARE:  MR. DOUGLAS E CRAMER  ABOC, NCLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOptician

General Provider Information

NPI Number : 1124168232
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS E CRAMER ABOC, NCLC
Provider Business Mailing Address
First Line : 511 WILSON AVE NW
Second Line : SUITE G
City : GRAND RAPIDS
State : MI
Zip : 49534-7986
Country : US
Telephone Number : 616-301-8663
Fax Number : 616-301-2987
Provider Business Practice Location Address
First Line : 511 WILSON AVE NW
Second Line : SUITE G
City : GRAND RAPIDS
State : MI
Zip : 49534-7986
Country : US
Telephone Number : 616-301-8663
Fax Number : 616-301-2987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/07/2007
Last Update Date : 07/09/2007

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Directions to “ MR. DOUGLAS E CRAMER ABOC, NCLC” Practice Location

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