Provider Demographics
NPI:1568492056
Name:ABRAMS, MITCHEL L (OD)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:L
Last Name:ABRAMS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64416
Mailing Address - Street 2:
Mailing Address - City:SOUDERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18964-0416
Mailing Address - Country:US
Mailing Address - Phone:215-723-2418
Mailing Address - Fax:
Practice Address - Street 1:15 W GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:SOUDERTON
Practice Address - State:PA
Practice Address - Zip Code:18964
Practice Address - Country:US
Practice Address - Phone:215-723-2418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE005073P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
32247OtherAETNA
32247OtherAETNA
PA0709940001Medicare NSC
T28653Medicare UPIN