Provider Demographics
NPI:1699744656
Name:KILGORE, ABBY C (OD)
Entity type:Individual
Prefix:DR
First Name:ABBY
Middle Name:C
Last Name:KILGORE
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 1:1950 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:314-994-4399
Practice Address - Fax:800-432-6004
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2011-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005021611152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2551322OtherUNITED HEALTHCARE
715396OtherHEALTHLINK
200726OtherBLUE CROSS BLUE SHIELD MO
UNKNOWNOtherGROUP HEALTH PLAN
32573OtherOPTICARE MED. COMPLETE
MO1611OtherEYEMED
UNKNOWNOtherMERCY HEALTH PLANS
UNKNOWNOtherDAVIS VISION
MO317412401Medicaid
MO317412419Medicaid
MO58747OtherHEALTHCARE USA
MO58747OtherHEALTHCARE USA
2551322OtherUNITED HEALTHCARE
32573OtherOPTICARE MED. COMPLETE
MO258771723Medicare PIN