Provider Demographics
NPI:1548493935
Name:ABRAHAM, JULIE (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:ABRAHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2863 EXECUTIVE PARK DR.
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331
Mailing Address - Country:US
Mailing Address - Phone:954-217-2992
Mailing Address - Fax:954-217-2245
Practice Address - Street 1:2863 EXECUTIVE PARK DR.
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331
Practice Address - Country:US
Practice Address - Phone:954-217-2992
Practice Address - Fax:954-217-2245
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4414152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCJ615YMedicare UPIN