Provider Demographics
NPI:1841278124
Name:ABRAMSON, BRUCE P (OD)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:P
Last Name:ABRAMSON
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 1:3035 CLEVELAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-2122
Mailing Address - Country:US
Mailing Address - Phone:707-545-3800
Mailing Address - Fax:707-528-4967
Practice Address - Street 1:3035 CLEVELAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2122
Practice Address - Country:US
Practice Address - Phone:707-545-3800
Practice Address - Fax:707-546-4112
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT9857T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01035539OtherRAILROAD MEDICARE
CASD0098571Medicaid
CASD0098571Medicaid
P01035539OtherRAILROAD MEDICARE
CAFV714ZMedicare PIN