Provider Demographics
NPI:1477561165
Name:DEAN, ALLAN O (OD)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:O
Last Name:DEAN
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 1:2724 CAPITAL CIR NE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4108
Mailing Address - Country:US
Mailing Address - Phone:850-385-4444
Mailing Address - Fax:850-386-5383
Practice Address - Street 1:2724 CAPITAL CIR NE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4108
Practice Address - Country:US
Practice Address - Phone:850-385-4444
Practice Address - Fax:850-386-5383
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39750Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
FLT84081Medicare UPIN