Provider Demographics
NPI:1053320051
Name:ALLSHOUSE, GERALD
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:ALLSHOUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-8424
Mailing Address - Country:US
Mailing Address - Phone:517-548-3571
Mailing Address - Fax:517-545-2543
Practice Address - Street 1:2790 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-8424
Practice Address - Country:US
Practice Address - Phone:517-548-3571
Practice Address - Fax:517-545-2543
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI028946OtherABOC