Provider Demographics
NPI:1114914876
Name:ALLRED, C. TROY (OD)
Entity Type:Individual
Prefix:DR
First Name:C. TROY
Middle Name:
Last Name:ALLRED
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 1:1601 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4015
Mailing Address - Country:US
Mailing Address - Phone:714-526-5515
Mailing Address - Fax:714-526-5384
Practice Address - Street 1:1601 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4015
Practice Address - Country:US
Practice Address - Phone:714-526-5515
Practice Address - Fax:714-526-5384
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11101T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWY061OtherGROUP MEDICARE #
CAGSD001700OtherGROUP MEDICAID #
CASD0111010Medicaid
CAW0P11101AMedicare ID - Type Unspecified
CAWY061OtherGROUP MEDICARE #