Provider Demographics
NPI:1417579194
Name:SMITH KENDALL, ABIGAIL LORRAINE (OD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LORRAINE
Last Name:SMITH KENDALL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:LORRAINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 843966
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-3966
Mailing Address - Country:US
Mailing Address - Phone:573-884-3300
Mailing Address - Fax:573-884-0943
Practice Address - Street 1:3215 WINGATE CT
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7214
Practice Address - Country:US
Practice Address - Phone:573-884-3937
Practice Address - Fax:573-884-4868
Is Sole Proprietor?:No
Enumeration Date:2020-05-15
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021021137152W00000X, 152WP0200X
ALS-E63-TA-B74152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist