Provider Demographics
NPI:1831256908
Name:KAMMER, DONALD ANDREW JR (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:ANDREW
Last Name:KAMMER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3174 WINSTED DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4394
Mailing Address - Country:US
Mailing Address - Phone:330-225-3252
Mailing Address - Fax:
Practice Address - Street 1:3760 ROCKY RIVER DR
Practice Address - Street 2:WEST PARK VISION CLINIC
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-4050
Practice Address - Country:US
Practice Address - Phone:216-941-3303
Practice Address - Fax:216-671-7447
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4466T1122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH6021480001Medicare NSC
OH0755727Medicare PIN
OHU49112Medicare UPIN
OH0755726Medicare PIN