Provider Demographics
NPI:1124168232
Name:CRAMER, DOUGLAS E (ABOC, NCLC)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:CRAMER
Suffix:
Gender:M
Credentials:ABOC, NCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WILSON AVE NW
Mailing Address - Street 2:SUITE G
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49534-7986
Mailing Address - Country:US
Mailing Address - Phone:616-301-8663
Mailing Address - Fax:616-301-2987
Practice Address - Street 1:511 WILSON AVE NW
Practice Address - Street 2:SUITE G
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49534-7986
Practice Address - Country:US
Practice Address - Phone:616-301-8663
Practice Address - Fax:616-301-2987
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5637270001Medicare NSC