Provider Demographics
NPI:1992385009
Name:ALLEN, KORY (OD)
Entity Type:Individual
Prefix:
First Name:KORY
Middle Name:
Last Name:ALLEN
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 1:610 SW MEADOW PT
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-8981
Mailing Address - Country:US
Mailing Address - Phone:817-781-2482
Mailing Address - Fax:
Practice Address - Street 1:3710 W SOUTHERN HILLS BLVD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8041
Practice Address - Country:US
Practice Address - Phone:196-004-7963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3107152W00000X
AR2843152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist