Provider Demographics
NPI:1659424927
Name:DAMMANN, CLARE M (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARE
Middle Name:M
Last Name:DAMMANN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:CLARE
Other - Middle Name:M
Other - Last Name:MANN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:502 S FREMONT AVE
Mailing Address - Street 2:APT 601
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2068
Mailing Address - Country:US
Mailing Address - Phone:336-324-7499
Mailing Address - Fax:
Practice Address - Street 1:502 S FREMONT AVE
Practice Address - Street 2:APT 601
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2068
Practice Address - Country:US
Practice Address - Phone:336-324-7499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001269152W00000X
FLOPC2722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009235264Medicaid
U62717Medicare UPIN