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General NPI Number Information
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NPI Number | 1013643246
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Entity Type | Individual
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Provider Name | BENJAMIN JOHNSTON ALLEN OD
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Gender | Male
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Dates
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Enumeration Date | 07/29/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 2613 SENTINEL WAY STE 400
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City | MELISSA
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State | TX
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Zip | 75454-2798
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Country | US
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Telephone | 432-692-4027
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 S MCDONALD ST APT 1222
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City | MCKINNEY
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State | TX
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Zip | 75069-1442
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Country | US
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Telephone | 806-333-3340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 10569T
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License Number State | TX
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