Provider Demographics
NPI:1174523724
Name:DOWNUM, ALLEN F JR (O D)
Entity type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:F
Last Name:DOWNUM
Suffix:JR
Gender:M
Credentials:O D
Other - Prefix:DR
Other - First Name:A
Other - Middle Name:F
Other - Last Name:DOWNUM
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:O D
Mailing Address - Street 1:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:EDENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27932-0809
Mailing Address - Country:US
Mailing Address - Phone:252-482-3218
Mailing Address - Fax:252-482-8444
Practice Address - Street 1:103 W EDEN ST
Practice Address - Street 2:
Practice Address - City:EDENTON
Practice Address - State:NC
Practice Address - Zip Code:27932-1843
Practice Address - Country:US
Practice Address - Phone:252-482-3218
Practice Address - Fax:252-482-8444
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC0774152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09239OtherBLUE CROSS BLUE SHIELD
NC8909239Medicaid
NCT64812Medicare UPIN
NC0617200001Medicare ID - Type UnspecifiedPALMETTO
NC246263Medicare ID - Type Unspecified