Basic Information
| Provider Information | |||||||||
| NPI: | 1104133883 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALLEN | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 EASTERN BLVD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174022906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177577023 | ||||||||
| FaxNumber: | 7177576517 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 EASTERN BLVD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174022906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177577023 | ||||||||
| FaxNumber: | 7177576517 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2010 | ||||||||
| LastUpdateDate: | 10/14/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OEG002355 | PA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0165770002 | 01 | PA | DMERC REGION A | OTHER | A12523766 | 01 | PA | BLUE SHIELD | OTHER |