Provider Demographics
NPI:1538922117
Name:ALLEN, KRIS (LICENSED OPTICIAN)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 S FORT APACHE RD STE 496
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-7700
Mailing Address - Country:US
Mailing Address - Phone:702-710-8780
Mailing Address - Fax:
Practice Address - Street 1:5510 S FORT APACHE RD STE 496
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-7700
Practice Address - Country:US
Practice Address - Phone:702-710-8780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV581156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician