Provider Demographics
NPI:1952579971
Name:ABIGAIL HOGLE FOWLER OD PLLC
Entity Type:Organization
Organization Name:ABIGAIL HOGLE FOWLER OD PLLC
Other - Org Name:ADVANCE VISION CENTER AND EYE WEAR BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:HOGLE
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-230-1273
Mailing Address - Street 1:860 S LYNN RIGGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-8301
Mailing Address - Country:US
Mailing Address - Phone:918-283-2273
Mailing Address - Fax:918-283-2273
Practice Address - Street 1:860 S LYNN RIGGS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-8301
Practice Address - Country:US
Practice Address - Phone:918-283-2273
Practice Address - Fax:918-283-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2492152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200130210AMedicaid
OK200130210AMedicaid
OKOKB5095Medicare PIN