Provider Demographics
NPI:1144294984
Name:RIDENOUR, ALISON SUE (OD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:SUE
Last Name:RIDENOUR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1051 E MAIN ST
Mailing Address - Street 2:UNIT 7
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-2318
Mailing Address - Country:US
Mailing Address - Phone:717-387-5657
Mailing Address - Fax:717-387-5638
Practice Address - Street 1:1051 E MAIN ST
Practice Address - Street 2:UNIT 7
Practice Address - City:WAYNESBORO
Practice Address - State:PA
Practice Address - Zip Code:17268-2318
Practice Address - Country:US
Practice Address - Phone:717-387-5657
Practice Address - Fax:717-387-5638
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2013-02-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDTA1411152W00000X
PAOEG001698152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA168913ZFBNMedicare PIN