Saul Ian Abraham, O.D.
Individual provider Active NPI Optometrist · Mt Prospect, IL
NPI 1285772400 · NPPES record last updated Oct 5, 2012
Key facts
- NPI
- 1285772400
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 046006649 (IL)
- Practice address
- 104 E Northwest Hwy
Mt Prospect, IL 60056-3232 - Phone
- (847) 398-3744
- Fax
- (847) 398-3744
- NPI assigned
- Feb 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046006649 | IL | Yes |
Addresses
Primary practice location
104 E Northwest Hwy
Mt Prospect, IL 60056-3232
Mailing address
104 E Northwest Hwy
Mt Prospect, IL 60056-3232
Phone (847) 398-3744
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 046006649 | Medicaid | IL |
Other providers in Mt Prospect, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.