Provider Demographics
NPI:1205888542
Name:AWAD, ABRAHAM B (OD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:B
Last Name:AWAD
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 1:1661 SW 37TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1754
Mailing Address - Country:US
Mailing Address - Phone:305-461-2400
Mailing Address - Fax:305-461-2902
Practice Address - Street 1:1661 SW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1754
Practice Address - Country:US
Practice Address - Phone:305-461-2400
Practice Address - Fax:305-461-2902
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2717152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0970830001OtherDME
FL084939100Medicaid
FL20472OtherBLUE CROSS BLUE SHEILD
FLU47671Medicare UPIN
FL084939100Medicaid