Provider Demographics
NPI:1659424497
Name:DAVID, ABIGAIL S (OD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:S
Last Name:DAVID
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 1:1775 MAYNARD DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5019
Mailing Address - Country:US
Mailing Address - Phone:317-787-7986
Mailing Address - Fax:
Practice Address - Street 1:895 S STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9413
Practice Address - Country:US
Practice Address - Phone:317-883-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist