Provider Demographics
NPI:1154594422
Name:WILLIAM D DELLANDE OD PC & J ANDREW KRAMER OD PC PARTNERS
Entity type:Organization
Organization Name:WILLIAM D DELLANDE OD PC & J ANDREW KRAMER OD PC PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-449-4188
Mailing Address - Street 1:111 E BROADWAY STE 310
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4208
Mailing Address - Country:US
Mailing Address - Phone:573-449-4188
Mailing Address - Fax:573-443-2842
Practice Address - Street 1:111 E BROADWAY STE 310
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4208
Practice Address - Country:US
Practice Address - Phone:573-449-4188
Practice Address - Fax:573-443-2842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO990000905Medicare PIN