Provider Demographics
NPI:1730798281
Name:ALLENSWORTH, NICHOLAS CASH (OD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:CASH
Last Name:ALLENSWORTH
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 1:3840 S BOULEVARD STE 101
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5888
Mailing Address - Country:US
Mailing Address - Phone:405-471-5252
Mailing Address - Fax:
Practice Address - Street 1:3840 S BOULEVARD STE 101
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-5888
Practice Address - Country:US
Practice Address - Phone:405-471-5252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-29
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist