Provider Demographics
NPI:1013643246
Name:ALLEN, BENJAMIN JOHNSTON (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:JOHNSTON
Last Name:ALLEN
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 1:2650 S MCDONALD ST APT 1222
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1442
Mailing Address - Country:US
Mailing Address - Phone:806-333-3340
Mailing Address - Fax:
Practice Address - Street 1:2613 SENTINEL WAY STE 400
Practice Address - Street 2:
Practice Address - City:MELISSA
Practice Address - State:TX
Practice Address - Zip Code:75454-2798
Practice Address - Country:US
Practice Address - Phone:432-692-4027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10569T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist