Provider Demographics
NPI:1104816461
Name:ALLEN, PATRICIA JANE (OD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:JANE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:JANE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:164 JUST A MERE DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30512-5124
Mailing Address - Country:US
Mailing Address - Phone:210-392-9144
Mailing Address - Fax:
Practice Address - Street 1:235 HWY 515 E, BLDG C
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512
Practice Address - Country:US
Practice Address - Phone:706-745-3900
Practice Address - Fax:706-745-2705
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002876152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist