Provider Demographics
NPI:1720208457
Name:PRICE, ALLISON (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3167 KINGSWOOD CT
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7545
Mailing Address - Country:US
Mailing Address - Phone:936-522-8155
Mailing Address - Fax:
Practice Address - Street 1:827 E LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-3504
Practice Address - Country:US
Practice Address - Phone:817-275-0655
Practice Address - Fax:817-275-0504
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6727T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX309203301Medicaid
TX309203302Medicaid
TX309203301Medicaid