Provider Demographics
NPI:1932723756
Name:TIMMERMAN, ABIGAIL GRACE (OD)
Entity Type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:GRACE
Last Name:TIMMERMAN
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 1:20063 SUNGLOW CT
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-8591
Mailing Address - Country:US
Mailing Address - Phone:231-557-8487
Mailing Address - Fax:
Practice Address - Street 1:450 HOOKAHI ST
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-1474
Practice Address - Country:US
Practice Address - Phone:808-877-3984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4510AATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist