Provider Demographics
NPI:1467010504
Name:CARR, ABIGAIL ROSE
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ROSE
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:ROSE
Other - Last Name:HEROTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:168 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5626
Mailing Address - Country:US
Mailing Address - Phone:207-784-3564
Mailing Address - Fax:207-782-2541
Practice Address - Street 1:168 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5626
Practice Address - Country:US
Practice Address - Phone:207-784-3564
Practice Address - Fax:207-782-2541
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME14478468152W00000X
MEOPT1015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist