Provider Demographics
NPI:1396054870
Name:ALLISON, DWIGHT JAY (OD)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:JAY
Last Name:ALLISON
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 1:6375 NE LOOP 820
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6035
Mailing Address - Country:US
Mailing Address - Phone:817-428-2323
Mailing Address - Fax:
Practice Address - Street 1:6375 NE LOOP 820
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-6035
Practice Address - Country:US
Practice Address - Phone:817-428-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4906T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist