Provider Demographics
NPI:1013106244
Name:ABRAMSON, JACK RODNEY (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:RODNEY
Last Name:ABRAMSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5555 DEZAVALA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-1735
Mailing Address - Country:US
Mailing Address - Phone:210-377-0668
Mailing Address - Fax:210-558-4551
Practice Address - Street 1:5555 DEZAVALA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1735
Practice Address - Country:US
Practice Address - Phone:210-377-0668
Practice Address - Fax:210-558-4551
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX520IT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U61020Medicare UPIN