Provider Demographics
NPI:1811985492
Name:PARIS, ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:PARIS
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 1:14401 N 29TH ST
Mailing Address - Street 2:PHOENIX
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-5003
Mailing Address - Country:US
Mailing Address - Phone:602-881-2710
Mailing Address - Fax:
Practice Address - Street 1:14401 N 29TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5003
Practice Address - Country:US
Practice Address - Phone:602-881-2710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ581152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ121608Medicare PIN
AZU31279Medicare UPIN
AZ78518Medicare ID - Type UnspecifiedMEDICARE/MEDICAID NUMBER