Provider Demographics
NPI:1093448276
Name:ALLEN, ANTHONY WAYNE JR
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:WAYNE
Last Name:ALLEN
Suffix:JR
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 1:499 INDIAN MOUND DR
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-1096
Mailing Address - Country:US
Mailing Address - Phone:859-497-9382
Mailing Address - Fax:
Practice Address - Street 1:499 INDIAN MOUND DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-1096
Practice Address - Country:US
Practice Address - Phone:859-497-9382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician