Provider Demographics
NPI:1679652853
Name:ALSOBROOK, RICHARD ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ALAN
Last Name:ALSOBROOK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7730 WOLF RIVER BLVD
Mailing Address - Street 2:101
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1708
Mailing Address - Country:US
Mailing Address - Phone:901-756-7002
Mailing Address - Fax:901-888-0026
Practice Address - Street 1:7730 WOLF RIVER BLVD
Practice Address - Street 2:101
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1708
Practice Address - Country:US
Practice Address - Phone:901-756-7002
Practice Address - Fax:901-888-0026
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3142220OtherBLUE CROSS BLUE CROSS
TNU13089Medicare UPIN
TN3842043Medicare ID - Type UnspecifiedMEDICARE
TN1279960001Medicare NSC