Provider Demographics
NPI:1083124390
Name:ZIKE, ABIGAIL MARIE (OD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:MARIE
Last Name:ZIKE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:MARIE
Other - Last Name:WILMES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10000 RESEARCH BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5814
Mailing Address - Country:US
Mailing Address - Phone:512-345-5642
Mailing Address - Fax:
Practice Address - Street 1:7400 SAN PEDRO AVE STE 486
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-8312
Practice Address - Country:US
Practice Address - Phone:210-541-0008
Practice Address - Fax:210-541-0038
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9269152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty