Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2492 | OK |
NPI | 1013021567 |
---|---|
Provider Name | Dr. Abigail Hogle Fowler |
First Address | Claremore, OK 74017-8301 |
Second Address | Claremore, OK 74017-8301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 12/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200102820A | (05) | OK |