Provider Demographics
NPI:1598242984
Name:ABE, KELLIE R M
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:R M
Last Name:ABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-166 KALANI ST STE 102
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1857
Mailing Address - Country:US
Mailing Address - Phone:808-329-3535
Mailing Address - Fax:
Practice Address - Street 1:75-166 KALANI ST STE 102
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1857
Practice Address - Country:US
Practice Address - Phone:808-329-3535
Practice Address - Fax:808-326-1821
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI890152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist