Active NPI
Brian A Allen, O.D.
- Optometrist
- Manistee, MI
National Provider Identifier
1205908654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003074
- Practice address
- 384 1St St
Manistee, MI 49660-1751 - Phone
- (231) 723-9911
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003074 | MI | Primary |
Addresses
Primary practice location
384 1St St
Manistee, MI 49660-1751
Mailing address
384 1St St
Manistee, MI 49660-1751
Phone (231) 723-9911
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1785092 | Medicaid | MI | |
| 410045293 | Other | MI | RR MEDICARE |
| 0E17604002 | Other | MI | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1231545600000",
"number": "1205908654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "384 1ST ST",
"city": "MANISTEE",
"state": "MI",
"postal_code": "496601751",
"telephone_number": "231-723-9911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "384 1ST ST",
"city": "MANISTEE",
"state": "MI",
"postal_code": "496601751",
"telephone_number": "231-723-9911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "BRIAN",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-14",
"last_updated": "2009-01-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003074",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1785092",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "410045293",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "0E17604002",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manistee, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.