Provider Demographics
NPI:1669493110
Name:KRAMER, ERIC L (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:L
Last Name:KRAMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1208 FLOYD AVE
Mailing Address - Street 2:BLDG. C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-2470
Mailing Address - Country:US
Mailing Address - Phone:209-521-7771
Mailing Address - Fax:209-521-4784
Practice Address - Street 1:1208 FLOYD AVE
Practice Address - Street 2:BLDG. C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-2470
Practice Address - Country:US
Practice Address - Phone:209-521-7771
Practice Address - Fax:209-521-4784
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6069T152W00000X, 152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0060690Medicaid
CASD0060690Medicaid
CA$$$$$$$$$OtherDME REGION D-MEDICARE
CASD0060690Medicare PIN
CASD0060690Medicaid