Provider Demographics
NPI:1922411214
Name:ABRAM, CASSANDRA (OD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:ABRAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 W MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-9664
Mailing Address - Country:US
Mailing Address - Phone:209-667-1213
Mailing Address - Fax:209-656-1009
Practice Address - Street 1:2010 W MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-9664
Practice Address - Country:US
Practice Address - Phone:209-667-1213
Practice Address - Fax:209-656-1009
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14940152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB222133Medicare PIN