Provider Demographics
NPI:1023161767
Name:ABBY KILGORE OD, PC
Entity type:Organization
Organization Name:ABBY KILGORE OD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:KILGORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-639-5004
Mailing Address - Street 1:1950 WENTZVILLE PARKWAY
Mailing Address - Street 2:WENTZVILLE EYE CENTER
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385
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:800-432-6004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO25888OtherSPECTERA
MO0471360027Medicare NSC
MO990001722Medicare PIN