Provider Demographics
NPI:1013021567
Name:FOWLER, ABIGAIL HOGLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:HOGLE
Last Name:FOWLER
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 1:860 S LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8301
Mailing Address - Country:US
Mailing Address - Phone:918-283-2020
Mailing Address - Fax:918-283-2273
Practice Address - Street 1:860 S LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8301
Practice Address - Country:US
Practice Address - Phone:918-283-2020
Practice Address - Fax:918-283-2273
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200102820AMedicaid
OKOK700149Medicare PIN