MEDICARE: CRYSTAL ANGELA RUEMENAPP O.D.

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	4901005466	MI

General Provider Information

NPI Number	:	1225636095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRYSTAL ANGELA RUEMENAPP O.D.

Provider Business Mailing Address
First Line	:	7418 N US 23
Second Line	:
City	:	OSCODA
State	:	MI
Zip	:	48750-8795
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1691 E US 23 STE 2
Second Line	:
City	:	EAST TAWAS
State	:	MI
Zip	:	48730-9337
Country	:	US
Telephone Number	:	989-362-9546
Fax Number	:	989-362-9567

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

Provider Enumeration Date	:	10/14/2020
Last Update Date	:	10/14/2020

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