Provider Demographics
NPI:1104114396
Name:KERR, ALLISON J (OD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:J
Last Name:KERR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:BURKESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42717-0966
Mailing Address - Country:US
Mailing Address - Phone:954-881-1402
Mailing Address - Fax:
Practice Address - Street 1:1256 CAMPBELL LN
Practice Address - Street 2:#106
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1082
Practice Address - Country:US
Practice Address - Phone:270-796-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1869DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100190120Medicaid