Provider Demographics
NPI:1013116524
Name:ALLARD, TYSON NEAL (OD)
Entity Type:Individual
Prefix:DR
First Name:TYSON
Middle Name:NEAL
Last Name:ALLARD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N HILL ST
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:OK
Mailing Address - Zip Code:73651-1641
Mailing Address - Country:US
Mailing Address - Phone:580-726-3301
Mailing Address - Fax:
Practice Address - Street 1:704 N HILL ST
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:OK
Practice Address - Zip Code:73651-1641
Practice Address - Country:US
Practice Address - Phone:580-726-3301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK298368YTNWMedicare PIN
OK6794580001Medicare NSC