Individual provider Active NPI

Craig J Gramelspacher, O.D.

  • Optometrist
  • Jasper, IN
National Provider Identifier
1689703605
Registry record updated Feb 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18001949B Issued in IN
Practice address
115 E 9TH St
Jasper, IN 47546-3010
Phone
(812) 482-1990
Fax
(812) 634-6845
NPI assigned
Mar 5, 2007
Last updated
Feb 22, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18001949B IN Primary

Addresses

Primary practice location

115 E 9TH St
Jasper, IN 47546-3010

Mailing address

PO Box 590
Jasper, IN 47547-0590
Phone (812) 482-1990

Other identifiers 1

IdentifierTypeStateIssuer
200068650AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18001949BINMDOptometrist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393027200000",
    "number": "1689703605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 590",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475470590",
            "telephone_number": "812-482-1990",
            "fax_number": "812-634-6845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 E 9TH ST",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475463010",
            "telephone_number": "812-482-1990",
            "fax_number": "812-634-6845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAMELSPACHER",
        "first_name": "CRAIG",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-05",
        "last_updated": "2014-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18001949B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200068650A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.