Healthcare Provider Details

I. General information

NPI: 1912842998
Provider Name (Legal Business Name): ABIGAIL WILHELMI
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BROOKTREE RD
WEXFORD PA
15090-9286
US

IV. Provider business mailing address

PO BOX 818
BEACH ND
58621-0818
US

V. Phone/Fax

Practice location:
  • Phone: 724-240-3682
  • Fax:
Mailing address:
  • Phone: 701-300-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG004367
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: