Provider Demographics
NPI:1285611624
Name:CRAMER, KAREN LYNNE (OD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LYNNE
Last Name:CRAMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4424 N SHERIDAN RD
Mailing Address - Street 2:20/20 EYECARE SOLUTIONS, INC.
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-5920
Mailing Address - Country:US
Mailing Address - Phone:309-427-2945
Mailing Address - Fax:309-427-2946
Practice Address - Street 1:301 W WASHINGTON
Practice Address - Street 2:20/20 EYECARE SOLUTIONS, INC.
Practice Address - City:EAST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61611-2036
Practice Address - Country:US
Practice Address - Phone:309-427-2945
Practice Address - Fax:309-427-2946
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA26568OtherIA GROUP MEDICARE
IA0207993Medicaid
IL977130OtherIL GROUP MEDICARE
IL046009232Medicaid
IL977130OtherIL GROUP MEDICARE
IL046009232Medicaid
IA15596Medicare PIN