Provider Demographics
NPI:1932159555
Name:ABEL, BURTON L (OD)
Entity type:Individual
Prefix:
First Name:BURTON
Middle Name:L
Last Name:ABEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S KANAWHA ST
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2320
Mailing Address - Country:US
Mailing Address - Phone:304-460-7326
Mailing Address - Fax:304-460-7328
Practice Address - Street 1:201 S KANAWHA ST
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2320
Practice Address - Country:US
Practice Address - Phone:304-460-7326
Practice Address - Fax:304-460-7328
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1024-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV616036500OtherDEPARTMENT OF LABOR NPI
WV1932159555OtherNPI
WV001772606OtherBCBS
WV3810003942Medicaid
WV3810016583OtherMEDICAID GROUP
WVAB4169574Medicare PIN
WV001772606OtherBCBS
WVV06624Medicare UPIN