Individual
WILLIAM RANDOLPH ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4597 MAIN ST, JASPER, TN 37347-3540
(423) 942-4400
(423) 942-4409
Mailing address
4597 MAIN ST, JASPER, TN 37347-3540
(423) 942-4400
(423) 942-4409
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT001454
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0158100
BLUE CROSS
TN
05
—
3598696
—
TN
Enumeration date
07/11/2006
Last updated
03/19/2008
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