Provider Demographics
NPI:1184756165
Name:ABRAHAM, SOBY (OD)
Entity type:Individual
Prefix:
First Name:SOBY
Middle Name:
Last Name:ABRAHAM
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 1:3121 N GEORGE BUSH HWY
Mailing Address - Street 2:SUITE#101
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-2752
Mailing Address - Country:US
Mailing Address - Phone:972-495-7772
Mailing Address - Fax:
Practice Address - Street 1:3121 N GEORGE BUSH FRWY.
Practice Address - Street 2:SUITE#101
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040
Practice Address - Country:US
Practice Address - Phone:972-495-7772
Practice Address - Fax:972-495-9393
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6502TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F8984Medicare PIN