Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 2637 | OK |
NPI | 1013116524 |
---|---|
Provider Name | Dr. Tyson Neal Allard |
First Address | Hobart, OK 73651-1641 |
Second Address | Hobart, OK 73651-1641 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2007 |
Last Update Date | 26/06/2014 |