Healthcare Provider Details

I. General information

NPI: 1629429865
Provider Name (Legal Business Name): ALLISON REBECCA OPTICAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 08/09/2021
Certification Date: 08/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ BARNES-JEWISH HOSPITAL
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

6408 E TANQUE VERDE RD
TUCSON AZ
85715-3809
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-5000
  • Fax:
Mailing address:
  • Phone: 520-885-5558
  • Fax: 520-885-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number63612
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number2016019462
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: