MEDICARE: DR. ALLYSON MERTINS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2462	AR

General Provider Information

NPI Number	:	1093719957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLYSON MERTINS OD

Provider Business Mailing Address
First Line	:	1188 N SALEM RD
Second Line	:	SUITE 12
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8807
Country	:	US
Telephone Number	:	479-442-8400
Fax Number	:	800-807-8144

Provider Business Practice Location Address
First Line	:	1188 N SALEM RD
Second Line	:	SUITE 12
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72704-8807
Country	:	US
Telephone Number	:	479-442-8400
Fax Number	:	800-807-8144

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	04/09/2008

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Directions to “ DR. ALLYSON MERTINS OD” Practice Location

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