Basic Information
| Provider Information | |||||||||
| NPI: | 1699744656 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KILGORE | ||||||||
| FirstName: | ABBY | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1950 WENTZVILLE PKWY | ||||||||
| Address2: | |||||||||
| City: | WENTZVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633853453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366395004 | ||||||||
| FaxNumber: | 6366395022 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 WENTZVILLE PKWY | ||||||||
| Address2: | |||||||||
| City: | WENTZVILLE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633853453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149944399 | ||||||||
| FaxNumber: | 8004326004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 12/26/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2005021611 | MO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 2551322 | 01 | UNITED HEALTHCARE | OTHER | 715396 | 01 | HEALTHLINK | OTHER | 200726 | 01 | BLUE CROSS BLUE SHIELD MO | OTHER | UNKNOWN | 01 | GROUP HEALTH PLAN | OTHER | 32573 | 01 | OPTICARE MED. COMPLETE | OTHER | MO1611 | 01 | EYEMED | OTHER | UNKNOWN | 01 | MERCY HEALTH PLANS | OTHER | UNKNOWN | 01 | DAVIS VISION | OTHER | 317412401 | 05 | MO | MEDICAID | 317412419 | 05 | MO | MEDICAID | 58747 | 01 | MO | HEALTHCARE USA | OTHER |