Provider Demographics
NPI:1639665540
Name:SHARP, ABIGAIL ELLEN (OD)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:ELLEN
Last Name:SHARP
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 1:2501 24TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201
Mailing Address - Country:US
Mailing Address - Phone:309-788-0604
Mailing Address - Fax:309-788-0611
Practice Address - Street 1:2501 24TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201
Practice Address - Country:US
Practice Address - Phone:309-788-0604
Practice Address - Fax:309-788-0611
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist