Provider Demographics
NPI:1841302320
Name:THOMAS, ABBY M (OD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:M
Last Name:THOMAS
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 1:2445 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-3257
Mailing Address - Country:US
Mailing Address - Phone:217-214-0299
Mailing Address - Fax:217-641-0028
Practice Address - Street 1:102 N 1ST AVE
Practice Address - Street 2:
Practice Address - City:WINTERSET
Practice Address - State:IA
Practice Address - Zip Code:50273-1551
Practice Address - Country:US
Practice Address - Phone:515-462-1254
Practice Address - Fax:217-641-0028
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1841302320Medicaid