Basic Information
| Provider Information | |||||||||
| NPI: | 1942365291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ABRAHAM | ||||||||
| FirstName: | CARMELA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 616 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444602935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303322080 | ||||||||
| FaxNumber: | 3303322123 | ||||||||
| Practice Location | |||||||||
| Address1: | 616 E STATE ST | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OH | ||||||||
| PostalCode: | 444602935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3303322080 | ||||||||
| FaxNumber: | 3303322123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 03/03/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WV0400X | 4169 | OH | Y | Eye and Vision Services Providers | Optometrist | Vision Therapy |
ID Information
| ID | Type | State | Issuer | Description | 0218839 | 05 | OH | MEDICAID |