Allen, William Randolph
Allen, William Randolph is an sole proprietor health care provider with primary practice located at 4597 Main St , Jasper TN 37347-3540. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Allen, William Randolph can be contacted via phone (423) 942-4400.Contact Information
Primary practice address
4597 Main St
Jasper TN 37347-3540
Phone: (423) 942-4400
Fax: (423) 942-4409
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | ODT001454 | Tennessee |
Profile Details
| NPI number | 1396770475 |
|---|---|
| LBN Legal business name | Allen, William Randolph |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 11th, 2006 |
| Last updated | Mar 19th, 2008 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1396770475 | NPPES |
| Tennessee | MEDICAID | 3598696 | |
| Tennessee | Other | 0158100 |
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