Healthcare Provider Details

I. General information

NPI: 1700856150
Provider Name (Legal Business Name): ALLAN L RHOADS O.D. (OPTOMETRIST)
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 02/18/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 OMRS / OPTOMETRY 701 HOSPITAL LOOP, SUITE 243
FAIRCHILD AFB WA
99011-8704
US

IV. Provider business mailing address

701 HOSPITAL LOOP STE 243
FAIRCHILD AFB WA
99011-8704
US

V. Phone/Fax

Practice location:
  • Phone: 509-247-5114
  • Fax: 509-247-2539
Mailing address:
  • Phone: 509-247-5114
  • Fax: 509-247-2539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC-2106
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00004111
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: