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NPI Code Detail

MEDICARE: DR. C. TROY ALLRED OD

MEDICARE: DR. C. TROY ALLRED OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist11101TCA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WY061OTHERCAGROUP MEDICARE #

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114914876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. C. TROY ALLRED OD
Provider Business Mailing Address
First Line : 1601 E CHAPMAN AVE
Second Line :
City : FULLERTON
State : CA
Zip : 92831-4015
Country : US
Telephone Number : 714-526-5515
Fax Number : 714-526-5384
Provider Business Practice Location Address
First Line : 1601 E CHAPMAN AVE
Second Line :
City : FULLERTON
State : CA
Zip : 92831-4015
Country : US
Telephone Number : 714-526-5515
Fax Number : 714-526-5384
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2005
Last Update Date : 07/17/2019

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