Provider Demographics
NPI:1700856150
Name:RHOADS, ALLAN L (OD (OPTOMETRIST))
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:L
Last Name:RHOADS
Suffix:
Gender:M
Credentials:OD (OPTOMETRIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 AMDS / OPTOMETRY
Mailing Address - Street 2:701 HOSPITAL LOOP, SUITE 355
Mailing Address - City:FAIRCHILD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:99011-8704
Mailing Address - Country:US
Mailing Address - Phone:509-247-5114
Mailing Address - Fax:509-247-5299
Practice Address - Street 1:92 AMDS / OPTOMETRY
Practice Address - Street 2:701 HOSPITAL LOOP, SUITE 355
Practice Address - City:FAIRCHILD AFB
Practice Address - State:WA
Practice Address - Zip Code:99011-8704
Practice Address - Country:US
Practice Address - Phone:509-247-5114
Practice Address - Fax:509-247-5299
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-2106152W00000X
WAOD 4111152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLVAD000Medicare UPIN