Provider Demographics
NPI:1083706881
Name:SCHRAMM, BETH ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:ANN
Last Name:SCHRAMM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2315
Mailing Address - Country:US
Mailing Address - Phone:860-423-2565
Mailing Address - Fax:
Practice Address - Street 1:16 WALNUT ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2315
Practice Address - Country:US
Practice Address - Phone:860-423-2565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2415152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU53146Medicare UPIN
CT410000794Medicare ID - Type Unspecified
CT1220860001Medicare NSC