Provider Demographics
NPI:1336129675
Name:MOK, ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:MOK
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 1:101 W. 84TH AVE, SUITE 240
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80260
Mailing Address - Country:US
Mailing Address - Phone:303-426-5550
Mailing Address - Fax:303-426-1180
Practice Address - Street 1:101 W 84TH AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80260-4807
Practice Address - Country:US
Practice Address - Phone:303-426-5550
Practice Address - Fax:303-426-1180
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2966152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ694514Medicaid
CO1336129675Medicaid
AZ74972Medicare ID - Type Unspecified
AZ694514Medicaid
CO1336129675Medicaid
CO385978Medicare PIN
AZU95383Medicare UPIN
AZ74973Medicare ID - Type Unspecified