Provider Demographics
NPI:1851022156
Name:PETTY, ALLISON (OD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PETTY
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 1:1000 CORPORATE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4128
Mailing Address - Country:US
Mailing Address - Phone:828-421-2958
Mailing Address - Fax:
Practice Address - Street 1:1000 CORPORATE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4128
Practice Address - Country:US
Practice Address - Phone:770-968-8888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-19
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003634152W00000X
KY262851156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician