Provider Demographics
NPI:1548297070
Name:ABINGDON EYE ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ABINGDON EYE ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:ELLISON
Authorized Official - Last Name:CONRAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-628-9141
Mailing Address - Street 1:418 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3408
Mailing Address - Country:US
Mailing Address - Phone:276-628-9141
Mailing Address - Fax:276-628-4441
Practice Address - Street 1:418 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3408
Practice Address - Country:US
Practice Address - Phone:276-628-9141
Practice Address - Fax:276-628-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021147207W00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Not Answered208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA078701OtherANTHEM
VA016335OtherOUT OF STATE BC CLAIMS
VAB06835Medicare UPIN