Provider Demographics
NPI:1821168790
Name:HOUSE, ALISON C (OD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:C
Last Name:HOUSE
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 1:1821 FORTINO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-1892
Mailing Address - Country:US
Mailing Address - Phone:719-583-0344
Mailing Address - Fax:719-583-2806
Practice Address - Street 1:1821 FORTINO BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1892
Practice Address - Country:US
Practice Address - Phone:719-583-0344
Practice Address - Fax:719-583-2806
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2015-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1360152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO312420OtherCORP. NPI - PTAN
CO312421YUSYOtherPERSONAL NPI - PTAN
CO312421YUSYOtherPERSONAL NPI - PTAN
T87055Medicare UPIN
CO312420OtherCORP. NPI - PTAN