Healthcare Provider Details

I. General information

NPI: 1588669790
Provider Name (Legal Business Name): THOMAS M ABRUZZI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1606 E MARKET ST
WARREN OH
44483-6613
US

IV. Provider business mailing address

1606 E MARKET ST
WARREN OH
44483-6613
US

V. Phone/Fax

Practice location:
  • Phone: 330-392-4191
  • Fax: 330-392-5031
Mailing address:
  • Phone: 330-392-4191
  • Fax: 330-392-5031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3657T336
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: