Provider Demographics
NPI:1962453662
Name:NEVERMANN, CRAIG L (OD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:L
Last Name:NEVERMANN
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 1:128 N TRATT ST
Mailing Address - Street 2:
Mailing Address - City:WHITEWATER
Mailing Address - State:WI
Mailing Address - Zip Code:53190-1205
Mailing Address - Country:US
Mailing Address - Phone:262-473-4514
Mailing Address - Fax:262-473-3161
Practice Address - Street 1:128 N TRATT ST
Practice Address - Street 2:
Practice Address - City:WHITEWATER
Practice Address - State:WI
Practice Address - Zip Code:53190-1205
Practice Address - Country:US
Practice Address - Phone:262-473-4514
Practice Address - Fax:262-473-3161
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1509-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38526400Medicaid
WI963OtherDEAN HEALTH INSURANCE
WINEVERCRAOtherMERCYCARE
WI1006591OtherPHYSICIANS PLUS
WI1006591OtherPHYSICIANS PLUS
WI38526400Medicaid
WI410046706Medicare PIN