Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 520IT | TX |
NPI | 1013106244 |
---|---|
Provider Name | Dr. Jack Rodney Abramson |
First Address | San Antonio, TX 78249-1735 |
Second Address | San Antonio, TX 78249-1735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2007 |
Last Update Date | 24/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U61020 | (02) |