Provider Demographics
NPI:1215927264
Name:FRAM, DAVID CANNON (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:CANNON
Last Name:FRAM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 E WACO DR
Mailing Address - Street 2:SUITE 545
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76705-3207
Mailing Address - Country:US
Mailing Address - Phone:254-741-6390
Mailing Address - Fax:254-741-6392
Practice Address - Street 1:2301 E WACO DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76705-3207
Practice Address - Country:US
Practice Address - Phone:254-741-6390
Practice Address - Fax:254-741-6392
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4804TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036640302Medicaid
TX036640302Medicaid
TX00498PMedicare ID - Type Unspecified