Provider Demographics
NPI:1316009566
Name:ALLGOOD, LARRY (OD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:ALLGOOD
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 1:11103 WEST AVE
Mailing Address - Street 2:STE 6
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-1370
Mailing Address - Country:US
Mailing Address - Phone:210-524-6803
Mailing Address - Fax:210-524-6587
Practice Address - Street 1:5870 E BROADWAY BLVD
Practice Address - Street 2:SPACE #506
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3914
Practice Address - Country:US
Practice Address - Phone:520-745-0229
Practice Address - Fax:520-745-5488
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZU98913Medicare UPIN
AZ106205Medicare ID - Type UnspecifiedMEDICARE