Healthcare Provider Details

I. General information

NPI: 1316289309
Provider Name (Legal Business Name): ALLISYN FEUCHT, O.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2013
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9372 DESCHUTES RD
PALO CEDRO CA
96073-8799
US

IV. Provider business mailing address

9372 DESCHUTES RD
PALO CEDRO CA
96073-8799
US

V. Phone/Fax

Practice location:
  • Phone: 530-547-2020
  • Fax: 530-547-2101
Mailing address:
  • Phone: 530-547-2020
  • Fax: 530-547-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number14232
License Number StateCA

VIII. Authorized Official

Name: DR. ALLISYN S FEUCHT
Title or Position: PRESIDENT/ OPTOMETRIST
Credential: O.D.
Phone: 530-547-2020