Healthcare Provider Details

I. General information

NPI: 1962664151
Provider Name (Legal Business Name): JOEL FRANCIS ALLISON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 06/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3051 E JACKSON BLVD
JACKSON MO
63755-2910
US

IV. Provider business mailing address

3051 E JACKSON BLVD
JACKSON MO
63755-2910
US

V. Phone/Fax

Practice location:
  • Phone: 573-204-7301
  • Fax: 573-204-7304
Mailing address:
  • Phone: 573-204-7301
  • Fax: 573-204-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT03308
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: