MEDICARE: DAVID CANNON FRAM OD

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
1	152W00000X	Optometrist	4804TG	TX
2	152WC0802X	Corneal and Contact Management Optometrist	4804TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215927264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID CANNON FRAM OD

Provider Business Mailing Address
First Line	:	2301 E WACO DR
Second Line	:	SUITE 545
City	:	WACO
State	:	TX
Zip	:	76705-3207
Country	:	US
Telephone Number	:	254-741-6390
Fax Number	:	254-741-6392

Provider Business Practice Location Address
First Line	:	2301 E WACO DR
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76705-3207
Country	:	US
Telephone Number	:	254-741-6390
Fax Number	:	254-741-6392

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	11/30/2011

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Directions to “ DAVID CANNON FRAM OD” Practice Location

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