Provider Demographics
NPI:1487643540
Name:KRAEMER, THOMAS ERROL (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ERROL
Last Name:KRAEMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3540 N BELT W
Mailing Address - Street 2:STE C
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-5975
Mailing Address - Country:US
Mailing Address - Phone:618-235-4433
Mailing Address - Fax:618-235-7483
Practice Address - Street 1:3540 N BELT W
Practice Address - Street 2:STE C
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5975
Practice Address - Country:US
Practice Address - Phone:618-235-4433
Practice Address - Fax:618-235-7483
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046 006468152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2203038OtherUNITED HEALTH CARE
IL8282033OtherBLUE CROSS BLUE SHIELD
239335OtherHEALTHLINK
400701OtherGHP ADVANTRA
5245266OtherAETNA
IL8282033OtherBLUE CROSS BLUE SHIELD
T37423Medicare UPIN