Provider Demographics
NPI:1316289309
Name:ALLISYN FEUCHT, O.D., INC.
Entity type:Organization
Organization Name:ALLISYN FEUCHT, O.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISYN
Authorized Official - Middle Name:S
Authorized Official - Last Name:FEUCHT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-547-2020
Mailing Address - Street 1:9372 DESCHUTES RD
Mailing Address - Street 2:
Mailing Address - City:PALO CEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:96073-8799
Mailing Address - Country:US
Mailing Address - Phone:530-547-2020
Mailing Address - Fax:530-547-2101
Practice Address - Street 1:9372 DESCHUTES RD
Practice Address - Street 2:
Practice Address - City:PALO CEDRO
Practice Address - State:CA
Practice Address - Zip Code:96073-8799
Practice Address - Country:US
Practice Address - Phone:530-547-2020
Practice Address - Fax:530-547-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14232152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1750679247OtherINDIVIDUAL NPI
CA6963150001Medicare NSC
CAHE527AMedicare PIN