Basic Information
| Provider Information | |||||||||
| NPI: | 1154352631 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRAMMER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 NEW YORK AVE SW | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871041646 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058188855 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1501 SAN PEDRO DR SE | ||||||||
| Address2: | PHYSICAL MEDICINE & REHAB SERVICE (117) | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871085153 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052651711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 04/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 604 | NM | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 592 | MT | N | Eye and Vision Services Providers | Optometrist | 152WL0500X | 604 | NM | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152WL0500X | 592 | MT | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152WL0500X | 1628 | CO | N | Eye and Vision Services Providers | Optometrist | Low Vision Rehabilitation | 152W00000X | 1628 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.