Provider Demographics
NPI:1770861411
Name:BROWN, ALLYSON NOELLE (OD)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:NOELLE
Last Name:BROWN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALLYSON
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 39116
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46239-0116
Mailing Address - Country:US
Mailing Address - Phone:318-505-5576
Mailing Address - Fax:
Practice Address - Street 1:SVS VISION OPTICAL CENTERS
Practice Address - Street 2:9419 WASHINGTON ST
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229
Practice Address - Country:US
Practice Address - Phone:317-895-8990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-29
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1610-643T152W00000X
IN18003893B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN18003893BOtherLICENSE NUMBER
LA1610-643TOtherLICENSE NUMBER
IN18003893AOtherLICENSE NUMBER