Larry James Allen, O.D.
Individual provider Active NPI Optometrist · Fort Payne, AL
NPI 1497846877 · NPPES record last updated Jun 6, 2008
Key facts
- NPI
- 1497846877
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- S 494 TA 004 (AL)
- Practice address
- 103 Grand Ave SW
Fort Payne, AL 35967-1915 - Phone
- (256) 845-0231
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S 494 TA 004 | AL | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | S 494 TA 004 | AL | Yes |
Addresses
Primary practice location
103 Grand Ave SW
Fort Payne, AL 35967-1915
Mailing address
PO Box 680317
Fort Payne, AL 35968-1604
Phone (256) 845-0231
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000059724 | Medicaid | AL | |
| 51059724 | Other | AL | BCBS OF ALABAMA |
Other providers in Fort Payne, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 6, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.