Provider Demographics
NPI:1902992886
Name:ABBONDANZA, JOHN MARK (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARK
Last Name:ABBONDANZA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:30 TURNPIKE RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2114
Mailing Address - Country:US
Mailing Address - Phone:508-481-8558
Mailing Address - Fax:508-848-3057
Practice Address - Street 1:30 TURNPIKE RD
Practice Address - Street 2:SUITE 7
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-2114
Practice Address - Country:US
Practice Address - Phone:508-481-8558
Practice Address - Fax:508-848-3057
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3407152W00000X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0369322Medicaid
MAW15945Medicare ID - Type UnspecifiedOPTOMETRY
MA0369322Medicaid