Provider Demographics
NPI:1871699173
Name:ALLEN, JOHN STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEVEN
Last Name:ALLEN
Suffix:
Gender:M
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:PO BOX 3063
Mailing Address - Street 2:
Mailing Address - City:KINGSFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49802
Mailing Address - Country:US
Mailing Address - Phone:715-251-4726
Mailing Address - Fax:
Practice Address - Street 1:1920 S. STEPHENSON AVE.
Practice Address - Street 2:
Practice Address - City:IRON MOUNTIAN
Practice Address - State:MI
Practice Address - Zip Code:49801
Practice Address - Country:US
Practice Address - Phone:906-119-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist