Basic Information
| Provider Information | |||||||||
| NPI: | 1437189461 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OVERLEY | ||||||||
| FirstName: | ALISON | ||||||||
| MiddleName: | MCDONALD | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 975 S LAUREL RD STE B | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407447862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068782020 | ||||||||
| FaxNumber: | 6068782055 | ||||||||
| Practice Location | |||||||||
| Address1: | 975 S LAUREL RD STE B | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407447862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068782020 | ||||||||
| FaxNumber: | 6068782055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/04/2006 | ||||||||
| LastUpdateDate: | 01/13/2010 | ||||||||
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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 | 1384DT | KY | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 77013845 | 05 | KY | MEDICAID |