Provider Demographics
NPI:1366431330
Name:ALLER, THOMAS A (OD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:ALLER
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 1:648 JENEVEIN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BRUNO
Mailing Address - State:CA
Mailing Address - Zip Code:94066-4230
Mailing Address - Country:US
Mailing Address - Phone:650-871-1816
Mailing Address - Fax:650-871-0164
Practice Address - Street 1:648 JENEVEIN AVE
Practice Address - Street 2:
Practice Address - City:SAN BRUNO
Practice Address - State:CA
Practice Address - Zip Code:94066-4230
Practice Address - Country:US
Practice Address - Phone:650-871-1816
Practice Address - Fax:650-871-0164
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7684T152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT10578Medicare UPIN
CASD0076840Medicare PIN