Provider Demographics
NPI:1538241864
Name:AUBERT, ALLEN JAMES (OD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:JAMES
Last Name:AUBERT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROCKY FORD
Mailing Address - State:CO
Mailing Address - Zip Code:81067-1704
Mailing Address - Country:US
Mailing Address - Phone:719-254-7404
Mailing Address - Fax:719-254-6820
Practice Address - Street 1:305 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ROCKY FORD
Practice Address - State:CO
Practice Address - Zip Code:81067-1704
Practice Address - Country:US
Practice Address - Phone:719-254-7404
Practice Address - Fax:719-254-6820
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9994499152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08009441Medicaid
CO410044783OtherRR MEDICARE
COT60769Medicare UPIN
COC487378Medicare Oscar/Certification
CO08009441Medicaid