Healthcare Provider Details

I. General information

NPI: 1760171524
Provider Name (Legal Business Name): ABIGAIL LOUISE WITMER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 NEIL AVE
COLUMBUS OH
43201-2333
US

IV. Provider business mailing address

1664 NEIL AVE
COLUMBUS OH
43201-2333
US

V. Phone/Fax

Practice location:
  • Phone: 614-688-0055
  • Fax: 614-247-6626
Mailing address:
  • Phone: 614-688-0055
  • Fax: 614-247-6626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT-258-TA-C92
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPT.007318
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: