1528547031 NPI number — ALLISON PAGE DICKSON OD

Table of content: ALLISON PAGE DICKSON OD (NPI 1528547031)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528547031 NPI number — ALLISON PAGE DICKSON OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKSON
Provider First Name:
ALLISON
Provider Middle Name:
PAGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEBSTER
Provider Other First Name:
ALLISON
Provider Other Middle Name:
PAGE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528547031
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1911 N MILLS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLANDO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32803-1407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-266-2393
Provider Business Mailing Address Fax Number:
727-266-2330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 S BELCHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33764-6301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-266-2393
Provider Business Practice Location Address Fax Number:
727-266-2330
Provider Enumeration Date:
08/07/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC5771 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 105742600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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