Healthcare Provider Details

I. General information

NPI: 1497867352
Provider Name (Legal Business Name): JOSEPH SCOTT ALLISON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 SAGEBRIAR DR
BRYAN TX
77802-6107
US

IV. Provider business mailing address

2102 CHIPPENDALE ST
COLLEGE STATION TX
77845-5581
US

V. Phone/Fax

Practice location:
  • Phone: 979-774-0498
  • Fax:
Mailing address:
  • Phone: 979-764-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number03111TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: