Provider Demographics
NPI:1811159361
Name:RONDEAU NELSON, ABBIE NELL (OD)
Entity type:Individual
Prefix:DR
First Name:ABBIE
Middle Name:NELL
Last Name:RONDEAU NELSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ABBIE
Other - Middle Name:
Other - Last Name:RONDEAU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2441NW PRAIRIE VIEW ROAD
Mailing Address - Street 2:
Mailing Address - City:PLATTE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64079
Mailing Address - Country:US
Mailing Address - Phone:816-858-2522
Mailing Address - Fax:816-858-2946
Practice Address - Street 1:2441NW PRAIRIE VIEW ROAD
Practice Address - Street 2:
Practice Address - City:PLATTE CITY
Practice Address - State:MO
Practice Address - Zip Code:64079
Practice Address - Country:US
Practice Address - Phone:816-858-2522
Practice Address - Fax:816-858-2946
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008017061152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1811159361Medicaid
MO1811159361Medicaid