Individual
LARRY JAMES ALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
103 GRAND AVE SW, FORT PAYNE, AL 35967-1915
(256) 845-0231
Mailing address
PO BOX 680317, FORT PAYNE, AL 35968-1604
(256) 845-0231
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S 494 TA 004
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000059724
—
AL
01
—
51059724
BCBS OF ALABAMA
AL
Enumeration date
09/28/2006
Last updated
06/06/2008
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