Provider Demographics
NPI:1659444891
Name:PILKINGTON, KIM N (OD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:N
Last Name:PILKINGTON
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:2825 S GLENSTONE AVE
Mailing Address - Street 2:SUITE 113 BATTLEFIELD MALL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-3732
Mailing Address - Country:US
Mailing Address - Phone:417-887-6883
Mailing Address - Fax:417-887-6884
Practice Address - Street 1:2825 S GLENSTONE AVE
Practice Address - Street 2:SUITE 113 BATTLEFIELD MALL
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-3732
Practice Address - Country:US
Practice Address - Phone:417-887-6883
Practice Address - Fax:417-887-6884
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOTO2699152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1730370305OtherGROUP NPI SPRINGFIELD EYECARE, LLC
MO000014257Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
MOU30682Medicare UPIN