Provider Demographics
NPI:1942928791
Name:WIRT, ALLISON (OD, MS)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:WIRT
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5031 FORD PKWY STE 113
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5287
Mailing Address - Country:US
Mailing Address - Phone:205-424-2733
Mailing Address - Fax:
Practice Address - Street 1:5031 FORD PKWY
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5283
Practice Address - Country:US
Practice Address - Phone:205-424-2733
Practice Address - Fax:888-424-6893
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-F11TA-C77152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist