Healthcare Provider Details

I. General information

NPI: 1770417198
Provider Name (Legal Business Name): MICHELLE KATHERINE ALLEN OD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N 179TH ST STE 203
OMAHA NE
68118-3569
US

IV. Provider business mailing address

304 N 179TH ST STE 203
OMAHA NE
68118-3569
US

V. Phone/Fax

Practice location:
  • Phone: 402-614-4322
  • Fax:
Mailing address:
  • Phone: 402-614-4322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1694
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: