Provider Demographics
NPI:1225093909
Name:ABBOTT, CALEB GALEN (OD)
Entity Type:Individual
Prefix:DR
First Name:CALEB
Middle Name:GALEN
Last Name:ABBOTT
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 1:424 E MAIN ST
Mailing Address - Street 2:PO BOX 231
Mailing Address - City:MARION
Mailing Address - State:KS
Mailing Address - Zip Code:66861-1534
Mailing Address - Country:US
Mailing Address - Phone:620-382-3113
Mailing Address - Fax:
Practice Address - Street 1:424 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:KS
Practice Address - Zip Code:66861-1534
Practice Address - Country:US
Practice Address - Phone:620-382-3113
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS09783152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS640880OtherFIRST GUARD
MO640880OtherFIRST GUARD
MO640880OtherFIRST GUARD