Provider Demographics
NPI:1871015149
Name:HEASLIP, ALLISON (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:HEASLIP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:100 S CREASY LN STE 1530
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-0757
Practice Address - Country:US
Practice Address - Phone:765-447-5083
Practice Address - Fax:765-448-4716
Is Sole Proprietor?:No
Enumeration Date:2017-07-08
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18004051A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist