Provider Demographics
NPI:1144944877
Name:ALLEN, AMY G (OD)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:G
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:G
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1240 BROOKSTONE CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-2954
Mailing Address - Country:US
Mailing Address - Phone:334-705-8803
Mailing Address - Fax:706-596-4849
Practice Address - Street 1:2460 INTERSTATE DR STE B
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-1534
Practice Address - Country:US
Practice Address - Phone:334-705-8803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-F14-TA-C83207WX0120X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALS-F14-TA-C83OtherOPTOMETRY