Provider Demographics
NPI:1730296005
Name:NEAL, ABIGAIL K (OD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:K
Last Name:NEAL
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:PO BOX 1506
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0409
Mailing Address - Country:US
Mailing Address - Phone:360-242-3008
Mailing Address - Fax:360-807-7687
Practice Address - Street 1:2915 S ALDER ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-4803
Practice Address - Country:US
Practice Address - Phone:253-473-0275
Practice Address - Fax:253-473-0706
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003488152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0483514Medicaid
WA1017713Medicaid
WAG8850020Medicare PIN
WAG8850017Medicare PIN
WAG355050Medicare PIN
WAG8850016Medicare PIN
WAG8850019Medicare PIN
MT000024151Medicare PIN