Provider Demographics
NPI:1053759886
Name:MADER, ABIGAIL DIANE (OD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:DIANE
Last Name:MADER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:
Other - Last Name:SOKOL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:118 CASS AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT CLEMENS
Mailing Address - State:MI
Mailing Address - Zip Code:48043-2204
Mailing Address - Country:US
Mailing Address - Phone:586-468-7370
Mailing Address - Fax:
Practice Address - Street 1:4786 RIDGE RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:OH
Practice Address - Zip Code:44144-3327
Practice Address - Country:US
Practice Address - Phone:740-361-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6233152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist