Provider Demographics
NPI:1285772400
Name:ABRAHAM, SAUL IAN (OD)
Entity type:Individual
Prefix:DR
First Name:SAUL
Middle Name:IAN
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 1:104 E NORTHWEST HWY
Mailing Address - Street 2:
Mailing Address - City:MT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-3232
Mailing Address - Country:US
Mailing Address - Phone:847-398-3744
Mailing Address - Fax:847-398-3744
Practice Address - Street 1:104 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3232
Practice Address - Country:US
Practice Address - Phone:847-398-3744
Practice Address - Fax:847-398-3744
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006649152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006649Medicaid