Provider Demographics
NPI:1720077043
Name:ABEL, GREGORY S (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:ABEL
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 1:2111 CUSTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-224-9880
Mailing Address - Fax:970-224-9881
Practice Address - Street 1:2111 CUSTER DRIVE
Practice Address - Street 2:
Practice Address - City:FT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-224-9880
Practice Address - Fax:970-224-9881
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO1941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29505526Medicaid
COU57053Medicare UPIN
CO29505526Medicaid
COCD1913Medicare PIN