Provider Demographics
NPI:1215030341
Name:DRAMEN, GAYLE DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:DIANE
Last Name:DRAMEN
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 1:2221 HIGHWAY 25 SE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-5308
Mailing Address - Country:US
Mailing Address - Phone:763-682-0055
Mailing Address - Fax:
Practice Address - Street 1:1315 HWY 25 SO
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313
Practice Address - Country:US
Practice Address - Phone:763-682-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2398152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN828591033166OtherPREF ONE
MN3C370DROtherBLUECROSS INDIVIDUAL #
MN21-12062OtherMEDICA DISPENSE/EAGAN
MN22-02652OtherMEDICA/BUFFALO
MN21-00523OtherMEDICA DISPENSE/BUFFALO
MN3C369DROtherBLUECROSS
MN22-13342OtherMEDICA/EAGAN
MN828591033166OtherPREF ONE