Provider Demographics
NPI:1972890861
Name:J. ANDREW KRAMER,O.D.,P.C.
Entity type:Organization
Organization Name:J. ANDREW KRAMER,O.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
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 1:3901 S PROVIDENCE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-7174
Mailing Address - Country:US
Mailing Address - Phone:573-449-4188
Mailing Address - Fax:573-443-2842
Practice Address - Street 1:3901 S PROVIDENCE RD
Practice Address - Street 2:SUITE B
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-7174
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:2011-06-30
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2679152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3460Medicare PIN
MO6691280001Medicare NSC