Provider Demographics
NPI:1730215864
Name:BRAMMER, CRAIG M
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:BRAMMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 N AVENUE F
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:LA
Mailing Address - Zip Code:70526-5044
Mailing Address - Country:US
Mailing Address - Phone:337-783-3072
Mailing Address - Fax:337-783-4982
Practice Address - Street 1:419 N AVENUE F
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:LA
Practice Address - Zip Code:70526-5044
Practice Address - Country:US
Practice Address - Phone:337-783-3072
Practice Address - Fax:337-783-4982
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA761-075T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA19477Medicare UPIN
LA0846190001Medicare NSC