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Individual

DR. CARL G ABBOTT

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
2753 SOUTH CLARK, MEXICO, MO 65265
(573) 581-8668
(573) 581-8850
Mailing address
11636 ACR 945, THOMPSON, MO 65285
(573) 581-8668

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03251
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
168751
BLUE CROSS BLUE SHIELD
MO
01
2353639
UNITED HEALTH CARE
01
53566
HEALTHCARE USA
MO
Enumeration date
11/10/2005
Last updated
07/08/2007
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