Healthcare Provider Details

I. General information

NPI: 1295143477
Provider Name (Legal Business Name): KARA ALLISON COLLIER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KARA ALLISON DIEBEL

II. Dates (important events)

Enumeration Date: 07/31/2014
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR TERRY BUILDING 1402
DAVIE FL
33328
US

IV. Provider business mailing address

5489 LENA RD
BRADENTON FL
34211-9449
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1402
  • Fax:
Mailing address:
  • Phone: 941-242-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOPC4943
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: