Basic Information
| Provider Information | |||||||||
| NPI: | 1508829656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 MALL BLVD | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194062902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104912125 | ||||||||
| FaxNumber: | 6103372133 | ||||||||
| Practice Location | |||||||||
| Address1: | 8112 ARLINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | FALLS CHURCH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220421002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038765766 | ||||||||
| FaxNumber: | 7038764936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2006 | ||||||||
| LastUpdateDate: | 09/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG001858 | PA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.