Healthcare Provider Details

I. General information

NPI: 1205888542
Provider Name (Legal Business Name): ABRAHAM B. AWAD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 01/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 SW 37TH AVE
MIAMI FL
33145-1754
US

IV. Provider business mailing address

1661 SW 37TH AVENUE
MIAMI FL
33145-1754
US

V. Phone/Fax

Practice location:
  • Phone: 305-461-2400
  • Fax: 305-461-2902
Mailing address:
  • Phone: 305-461-2400
  • Fax: 305-461-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 2717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: