Provider Demographics
NPI:1063597342
Name:ABRAHAM, JAMES M (O D)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4995 ATWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-4964
Mailing Address - Country:US
Mailing Address - Phone:801-288-0882
Mailing Address - Fax:801-288-0977
Practice Address - Street 1:4995 ATWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-4964
Practice Address - Country:US
Practice Address - Phone:801-288-0882
Practice Address - Fax:801-288-0977
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT931122779934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTF0451Medicare UPIN
UTU000074337Medicare PIN