Provider Demographics
NPI:1164423208
Name:LALLANDE, ALLEN PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:PAUL
Last Name:LALLANDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:PAUL
Other - Middle Name:
Other - Last Name:LALLANDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:125 SUFFOLK AVE
Mailing Address - Street 2:
Mailing Address - City:RICHLANDS
Mailing Address - State:VA
Mailing Address - Zip Code:24641-2434
Mailing Address - Country:US
Mailing Address - Phone:276-963-0808
Mailing Address - Fax:276-963-7538
Practice Address - Street 1:125 SUFFOLK AVE
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2434
Practice Address - Country:US
Practice Address - Phone:276-963-0808
Practice Address - Fax:276-963-7538
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA021335OtherANTHEM BC/BS #
VA009203567Medicaid
VA021335OtherANTHEM BC/BS #
T21898Medicare UPIN
VA0192560001Medicare NSC
VA00X721P01Medicare PIN