Provider Demographics
NPI:1154352631
Name:CRAMMER, ROBERT J (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:CRAMMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2420 NEW YORK AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-1646
Mailing Address - Country:US
Mailing Address - Phone:505-818-8855
Mailing Address - Fax:
Practice Address - Street 1:1501 SAN PEDRO DR SE
Practice Address - Street 2:PHYSICAL MEDICINE & REHAB SERVICE (117)
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5153
Practice Address - Country:US
Practice Address - Phone:505-265-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM604152W00000X, 152WL0500X
MT592152W00000X, 152WL0500X
CO1628152WL0500X, 152W00000X, 152WL0500X
AK283152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU59401Medicare UPIN