Provider Demographics
NPI:1962664151
Name:ALLISON, JOEL FRANCIS (OD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:FRANCIS
Last Name:ALLISON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3051 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-2910
Mailing Address - Country:US
Mailing Address - Phone:573-204-7301
Mailing Address - Fax:573-204-7304
Practice Address - Street 1:3051 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-2910
Practice Address - Country:US
Practice Address - Phone:573-204-7301
Practice Address - Fax:573-204-7304
Is Sole Proprietor?:No
Enumeration Date:2008-06-28
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO00091065Medicare UPIN