Provider Demographics
NPI:1720194764
Name:ABRAMSON, ANNEMARIE VITKA (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNEMARIE
Middle Name:VITKA
Last Name:ABRAMSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANNEMARIE
Other - Middle Name:MARGARET
Other - Last Name:VITKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3600 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06705-3851
Mailing Address - Country:US
Mailing Address - Phone:203-596-0406
Mailing Address - Fax:
Practice Address - Street 1:3600 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-3851
Practice Address - Country:US
Practice Address - Phone:203-596-0406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090002363CT01OtherANTHEM BLUE CROSS/BLUE SH
CTU83504Medicare UPIN