Provider Demographics
NPI:1245373893
Name:STRAMM, KENNETH M (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:M
Last Name:STRAMM
Suffix:
Gender:M
Credentials:OPTICIAN
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Other - Credentials:
Mailing Address - Street 1:THE EYE CARE CENTER OF GOOSE CREEK
Mailing Address - Street 2:142 SAINT JAMES AVE
Mailing Address - City:GOOSE CREEK
Mailing Address - State:SC
Mailing Address - Zip Code:29445-2973
Mailing Address - Country:US
Mailing Address - Phone:843-572-2266
Mailing Address - Fax:843-572-0620
Practice Address - Street 1:EYECARE CENTER OF GOOSE CREEK
Practice Address - Street 2:142 SAINT JAMES AVE
Practice Address - City:GOOSE CREEK
Practice Address - State:SC
Practice Address - Zip Code:29445-2973
Practice Address - Country:US
Practice Address - Phone:843-572-2266
Practice Address - Fax:843-572-0620
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC328156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV3283Medicaid
SC0687400001Medicare NSC