Healthcare Provider Details

I. General information

NPI: 1881611887
Provider Name (Legal Business Name): JACK E ABRAMS M D PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 MEDICAL CENTER ST #100
LAS VEGAS NV
89148-2405
US

IV. Provider business mailing address

4800 N 22ND ST STE 200
PHOENIX AZ
85016-4963
US

V. Phone/Fax

Practice location:
  • Phone: 702-304-9494
  • Fax: 702-304-9495
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number9777
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JACK E ABRAMS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 702-304-9494