Provider Demographics
NPI:1962404061
Name:MCALLISTER, LLOYD D (OD)
Entity type:Individual
Prefix:
First Name:LLOYD
Middle Name:D
Last Name:MCALLISTER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3346 CINEMA PT
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2815
Mailing Address - Country:US
Mailing Address - Phone:719-591-1229
Mailing Address - Fax:719-637-2560
Practice Address - Street 1:5755 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3684
Practice Address - Country:US
Practice Address - Phone:719-548-8717
Practice Address - Fax:719-548-8932
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2017-02-15
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CO1230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U06197Medicare UPIN
COC42673Medicare PIN