Provider Demographics
NPI:1093719957
Name:MERTINS, ALLYSON (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:
Last Name:MERTINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 N SALEM RD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-8807
Mailing Address - Country:US
Mailing Address - Phone:479-442-8400
Mailing Address - Fax:800-807-8144
Practice Address - Street 1:1188 N SALEM RD
Practice Address - Street 2:SUITE 12
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-8807
Practice Address - Country:US
Practice Address - Phone:479-442-8400
Practice Address - Fax:800-807-8144
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2462152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR49239Medicare PIN
ARU66956Medicare UPIN