Provider Demographics
NPI:1902989098
Name:ABRAMSON, CLARK M (OD)
Entity type:Individual
Prefix:DR
First Name:CLARK
Middle Name:M
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 1:575 ESCONDIDO CIR
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-5252
Mailing Address - Country:US
Mailing Address - Phone:925-447-3883
Mailing Address - Fax:925-447-3893
Practice Address - Street 1:1800 4TH ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4454
Practice Address - Country:US
Practice Address - Phone:925-447-3883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5491T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMA0648343OtherDEA
CAT10009Medicare UPIN
SD0054910Medicare ID - Type Unspecified