Provider Demographics
NPI:1114040342
Name:RISING, ALAN RAY SR (OD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:RAY
Last Name:RISING
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6420B EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-4321
Mailing Address - Country:US
Mailing Address - Phone:409-899-5340
Mailing Address - Fax:409-899-3530
Practice Address - Street 1:6420B EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-4321
Practice Address - Country:US
Practice Address - Phone:409-899-5340
Practice Address - Fax:409-899-3530
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3213TG152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121605303Medicaid
TX00E04KOtherBLUE CROSS
TX00E04KMedicare ID - Type UnspecifiedMECICARE
TX00E04KOtherBLUE CROSS