Provider Demographics
NPI:1922150762
Name:ABBY KILGORE O.D,P.C.
Entity Type:Organization
Organization Name:ABBY KILGORE O.D,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:C
Authorized Official - Last Name:KILOGRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-993-4399
Mailing Address - Street 1:9838 CLAYTON RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1604
Mailing Address - Country:US
Mailing Address - Phone:314-993-4399
Mailing Address - Fax:314-567-3989
Practice Address - Street 1:9838 CLAYTON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1604
Practice Address - Country:US
Practice Address - Phone:314-993-4399
Practice Address - Fax:314-567-3989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO14053OtherSPECTERA
MO990001722Medicare PIN
MO0471360005Medicare NSC