Healthcare Provider Details

I. General information

NPI: 1336766153
Provider Name (Legal Business Name): ABIGAIL HARTLE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABIGAIL MAYNARD OD

II. Dates (important events)

Enumeration Date: 06/27/2020
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3390 E JOLLY RD
LANSING MI
48910-8547
US

IV. Provider business mailing address

1515 LAKE LANSING RD STE H
LANSING MI
48912-3752
US

V. Phone/Fax

Practice location:
  • Phone: 269-342-1405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005453
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: