Provider Demographics
NPI:1891829529
Name:CRAMER, DAVID CARL (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CARL
Last Name:CRAMER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N MAIN ST
Mailing Address - Street 2:SUITE B 13
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4080
Mailing Address - Country:US
Mailing Address - Phone:406-752-7419
Mailing Address - Fax:406-756-7353
Practice Address - Street 1:20 N MAIN ST
Practice Address - Street 2:SUITE B 13
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4080
Practice Address - Country:US
Practice Address - Phone:406-752-7419
Practice Address - Fax:406-756-7353
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000480998Medicaid