Provider Demographics
NPI:1588649537
Name:PRESTON, KERRY C (OD)
Entity Type:Individual
Prefix:DR
First Name:KERRY
Middle Name:C
Last Name:PRESTON
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 1:2120 ANTILLEY RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5211
Mailing Address - Country:US
Mailing Address - Phone:325-695-2020
Mailing Address - Fax:
Practice Address - Street 1:2120 ANTILLEY RD
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5211
Practice Address - Country:US
Practice Address - Phone:325-695-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT95927152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410025679OtherRRMC
TX041128201Medicaid
751531889OtherTAX ID
TX81A049OtherBCBS
TX82A049Medicare ID - Type Unspecified
751531889OtherTAX ID