Provider Demographics
NPI:1023120763
Name:DRAMEN, GORDON EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:GORDON
Middle Name:EUGENE
Last Name:DRAMEN
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 1:2221 HIGHWAY 25 SE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-5308
Mailing Address - Country:US
Mailing Address - Phone:763-682-0055
Mailing Address - Fax:
Practice Address - Street 1:380 33RD AVE S
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56301-3716
Practice Address - Country:US
Practice Address - Phone:320-259-5880
Practice Address - Fax:320-259-6084
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2399152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN22-01743OtherMEDICA / BAXTER
MNP00024753OtherRAILROAD
MN395751014996OtherPREFERRED ONE
MN6C285DBOtherBCBS/ BAXTER
MN22-01742OtherMEDICA / ST CLOUD
MN497SODROtherBCBS
MN22-01741OtherMEDICA / EAGAN
MN6C285DBOtherBCBS/ BAXTER