Provider Demographics
NPI:1518906106
Name:ALLEN, VALERIE DENISE (OD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:DENISE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 KINGS CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-1603
Mailing Address - Country:US
Mailing Address - Phone:912-219-5826
Mailing Address - Fax:
Practice Address - Street 1:4120 E MCCAIN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72117-2533
Practice Address - Country:US
Practice Address - Phone:501-223-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2684152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11478247OtherCAQH
U82950Medicare UPIN
IN11478247OtherCAQH