Kenneth W Abbott, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

0102595A Issued in IN

Practice address

2222 W Lexington Ave
Elkhart, IN 46514-1420

Phone

(574) 294-3030

Fax

(574) 294-3544

NPI assigned

Oct 18, 2006

Last updated

Jan 8, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Abbott Eye Clinic Inc PC

  dba Image Optical

  • Ophthalmology Physician
  • Elkhart, IN
  • NPI 1831268150
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452211200000",
    "number": "1770664138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2968",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465152968",
            "telephone_number": "574-296-3200",
            "fax_number": "574-296-3544"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 W LEXINGTON AVE",
            "city": "ELKHART",
            "state": "IN",
            "postal_code": "465141420",
            "telephone_number": "574-294-3030",
            "fax_number": "574-294-3544"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABBOTT",
        "first_name": "KENNETH",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2016-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IN",
            "license": "0102595A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112470",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "180041763",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 111 Home Health Care Agency
• 111Home Health Care Agency (111Home Personal Care Agency)
• 42 North Dental Care of Indiana, LLC (Greenleaf Family Dentistry)
• Abbott Eye Clinic Inc PC (Image Optical)
• Gerald Abell II, RBT
• Jad Abou Rjeily, RPH
• Matthew Lee Abrell, DPM
• Davida Acheampong, MSW
• Marcos Acosta, MA

• Ophthalmology Physician in Elkhart, IN
• Providers in Elkhart, IN by specialty
• Ophthalmology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.