Provider Demographics
NPI:1518659044
Name:ALLEN, COLE (OD)
Entity Type:Individual
Prefix:
First Name:COLE
Middle Name:
Last Name:ALLEN
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:PO BOX 9782
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89507-9782
Mailing Address - Country:US
Mailing Address - Phone:775-507-0410
Mailing Address - Fax:
Practice Address - Street 1:236 W 6TH ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4549
Practice Address - Country:US
Practice Address - Phone:775-322-4061
Practice Address - Fax:775-322-6603
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007152152W00000X
NV1159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist