Provider Demographics
NPI:1316397615
Name:MOORE, ABIGAIL RICHIE (OD)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:RICHIE
Last Name:MOORE
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 1:2715 DAMON ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3899
Mailing Address - Country:US
Mailing Address - Phone:715-834-8471
Mailing Address - Fax:
Practice Address - Street 1:2715 DAMON ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3899
Practice Address - Country:US
Practice Address - Phone:715-834-8471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3485152W00000X
WI3610-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist