Provider Demographics
NPI:1770897076
Name:KILGORE, ELIZABETH M (OD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:KILGORE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:197 HOSPITAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:72529-7315
Mailing Address - Country:US
Mailing Address - Phone:870-257-2100
Mailing Address - Fax:870-257-4395
Practice Address - Street 1:197 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:CHEROKEE VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:72529-7315
Practice Address - Country:US
Practice Address - Phone:870-257-2100
Practice Address - Fax:870-257-4395
Is Sole Proprietor?:No
Enumeration Date:2010-07-29
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2656152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist