Provider Demographics
NPI:1114986270
Name:ALLAN, STUART K (OD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:K
Last Name:ALLAN
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 1:75 E 200 S
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741
Mailing Address - Country:US
Mailing Address - Phone:435-644-5717
Mailing Address - Fax:435-644-5790
Practice Address - Street 1:75 E 200 S
Practice Address - Street 2:SUITE 1
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741
Practice Address - Country:US
Practice Address - Phone:435-644-5717
Practice Address - Fax:435-644-5790
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3755239934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTMA0445418OtherDEA
UT005730001Medicare ID - Type Unspecified
U75327Medicare UPIN