Provider Demographics
NPI:1689768517
Name:BANDY, ALLEN HILL JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:HILL
Last Name:BANDY
Suffix:JR
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 25
Mailing Address - Street 2:21 SOUTH MAIN AVE
Mailing Address - City:NEWTON
Mailing Address - State:NC
Mailing Address - Zip Code:28658-0025
Mailing Address - Country:US
Mailing Address - Phone:828-464-0604
Mailing Address - Fax:828-464-0982
Practice Address - Street 1:21 S MAIN AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NC
Practice Address - Zip Code:28658-3318
Practice Address - Country:US
Practice Address - Phone:828-464-0604
Practice Address - Fax:828-464-0982
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1220152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09056OtherBCBS
NC09091OtherBCBS GROUP # (1 DR)
NCE3075OtherMEDCOST PROV #
NC8909091Medicaid
NC7909056Medicaid
NC09056OtherBCBS
NC8909091Medicaid
NCE3075OtherMEDCOST PROV #