Provider Demographics
NPI:1558563064
Name:CRAM, BRUCE (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:
Last Name:CRAM
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 SHERIDAN AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:CODY
Mailing Address - State:WY
Mailing Address - Zip Code:82414-3423
Mailing Address - Country:US
Mailing Address - Phone:307-587-5578
Mailing Address - Fax:307-587-4796
Practice Address - Street 1:721 SHERIDAN AVE
Practice Address - Street 2:SUITE 280
Practice Address - City:CODY
Practice Address - State:WY
Practice Address - Zip Code:82414-3423
Practice Address - Country:US
Practice Address - Phone:307-587-5578
Practice Address - Fax:307-587-4796
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYF33909Medicare UPIN
WY1263040001Medicare ID - Type Unspecified