Provider Demographics
NPI:1043051246
Name:CHILTON, ALLISON (OD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:CHILTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 E BROAD ST APT 3129
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3076
Mailing Address - Country:US
Mailing Address - Phone:401-835-3191
Mailing Address - Fax:
Practice Address - Street 1:765 HAYWOOD RD STE B1
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2772
Practice Address - Country:US
Practice Address - Phone:864-234-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCOPT.2485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist