Provider Demographics
NPI:1104109446
Name:MAUS, ABBY (OD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:
Last Name:MAUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 FRANKLIN RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1816
Mailing Address - Country:US
Mailing Address - Phone:989-372-4766
Mailing Address - Fax:
Practice Address - Street 1:29245 RYAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-4284
Practice Address - Country:US
Practice Address - Phone:586-558-2981
Practice Address - Fax:586-558-8838
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist