Provider Demographics
NPI:1477816262
Name:GARMON, ALLISON MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:MARIE
Last Name:GARMON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALLISON
Other - Middle Name:MARIE
Other - Last Name:BURROUGHS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:109 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563-2142
Mailing Address - Country:US
Mailing Address - Phone:574-936-2272
Mailing Address - Fax:
Practice Address - Street 1:109 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-2142
Practice Address - Country:US
Practice Address - Phone:574-936-2272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003737A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201079890Medicaid
IN201079890Medicaid