Provider Demographics
NPI:1417122383
Name:PEPELEA, ALISSA DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALISSA
Middle Name:DIANE
Last Name:PEPELEA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ALISSA
Other - Middle Name:DIANE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2152 ABERDEEN CIR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2004
Mailing Address - Country:US
Mailing Address - Phone:317-289-3189
Mailing Address - Fax:
Practice Address - Street 1:125 JOHN R RICE BLVD
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-4165
Practice Address - Country:US
Practice Address - Phone:615-904-9460
Practice Address - Fax:615-904-1924
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003083A152W00000X
TN2866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist