Provider Demographics
NPI:1144476839
Name:ABBY KILGORE O.D,P.C.
Entity type:Organization
Organization Name:ABBY KILGORE O.D,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-639-5004
Mailing Address - Street 1:1950 WENTZVILLE PKWY
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-3453
Mailing Address - Country:US
Mailing Address - Phone:636-639-5004
Mailing Address - Fax:636-639-5022
Practice Address - Street 1:1950 WENTZVILLE PKWY
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-3453
Practice Address - Country:US
Practice Address - Phone:636-639-5004
Practice Address - Fax:636-639-5022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOV06432Medicare UPIN