Provider Demographics
NPI:1053597112
Name:SCHOONOVER, ABBY J (OD)
Entity type:Individual
Prefix:
First Name:ABBY
Middle Name:J
Last Name:SCHOONOVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:J
Other - Last Name:OUTLAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2105 BIGHORN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3555
Mailing Address - Country:US
Mailing Address - Phone:970-377-0005
Mailing Address - Fax:970-377-2520
Practice Address - Street 1:2105 BIGHORN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3555
Practice Address - Country:US
Practice Address - Phone:970-377-0005
Practice Address - Fax:970-377-2520
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2607152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO41137Medicare UPIN