Provider Demographics
NPI:1942821905
Name:NATHAN ABRAHAM MD VISION PROFESSIONALS INC
Entity Type:Organization
Organization Name:NATHAN ABRAHAM MD VISION PROFESSIONALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-645-6660
Mailing Address - Street 1:11344 LOMA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3313
Mailing Address - Country:US
Mailing Address - Phone:909-645-6660
Mailing Address - Fax:
Practice Address - Street 1:24305 TOWN CENTER DR STE 160
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-1347
Practice Address - Country:US
Practice Address - Phone:661-799-7464
Practice Address - Fax:661-799-7583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1306224456OtherNPPS