1285611624 NPI number — DR. KAREN LYNNE CRAMER OD

Table of content: MELISSA MORTON LCSW (NPI 1831865005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285611624 NPI number — DR. KAREN LYNNE CRAMER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAMER
Provider First Name:
KAREN
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285611624
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4424 N SHERIDAN RD
Provider Second Line Business Mailing Address:
20/20 EYECARE SOLUTIONS, INC.
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61614-5920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-427-2945
Provider Business Mailing Address Fax Number:
309-427-2946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 W WASHINGTON
Provider Second Line Business Practice Location Address:
20/20 EYECARE SOLUTIONS, INC.
Provider Business Practice Location Address City Name:
EAST PEORIA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61611-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-427-2945
Provider Business Practice Location Address Fax Number:
309-427-2946
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  046009232 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 26568 . This is a "IA GROUP MEDICARE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 0207993 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 977130 . This is a "IL GROUP MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 046009232 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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