Provider Demographics
NPI:1417048281
Name:ABRASSANT RAMSEY, RENEE T
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:T
Last Name:ABRASSANT RAMSEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:T
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47567
Mailing Address - Country:US
Mailing Address - Phone:812-354-3331
Mailing Address - Fax:812-354-3331
Practice Address - Street 1:601 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47567-1247
Practice Address - Country:US
Practice Address - Phone:812-354-3331
Practice Address - Fax:812-354-3331
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002013 B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100154830AMedicaid
IN100154830AMedicaid
IN0294800001Medicare NSC
IN442910Medicare PIN