Provider Demographics
NPI:1558393504
Name:KRAMER, MARK W (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:KRAMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1001 E MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2202
Mailing Address - Country:US
Mailing Address - Phone:630-584-1111
Mailing Address - Fax:630-584-1239
Practice Address - Street 1:1001 E MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2202
Practice Address - Country:US
Practice Address - Phone:630-584-1111
Practice Address - Fax:630-584-1239
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL46-008116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL572560Medicare ID - Type Unspecified