Provider Demographics
NPI:1366794604
Name:ABRAHAMSON, MELISSA ANN (OD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:ANN
Last Name:ABRAHAMSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830E CENTURY AVE 1
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0639
Mailing Address - Country:US
Mailing Address - Phone:701-222-1140
Mailing Address - Fax:
Practice Address - Street 1:1830 E CENTURY AVE UNIT 1
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0639
Practice Address - Country:US
Practice Address - Phone:701-222-1140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ND740152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program