Provider Demographics
NPI:1083141857
Name:EYE CARE INSTITUTE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EYE CARE INSTITUTE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:ABRAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:707-525-6485
Mailing Address - Street 1:3035 CLEVELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2122
Mailing Address - Country:US
Mailing Address - Phone:707-545-3800
Mailing Address - Fax:
Practice Address - Street 1:3035 CLEVELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3037
Practice Address - Country:US
Practice Address - Phone:707-546-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA189185Medicare PIN