Provider Demographics
NPI:1548344690
Name:ALEXANDER, EDWARD WARREN (OD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WARREN
Last Name:ALEXANDER
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 11689
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0689
Mailing Address - Country:US
Mailing Address - Phone:518-368-6571
Mailing Address - Fax:
Practice Address - Street 1:BOSCOV'S OPTICAL
Practice Address - Street 2:422 CIFTON PARK CENTER ROAD
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065
Practice Address - Country:US
Practice Address - Phone:518-383-9838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005865152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10025383OtherCDPHP
NY318340OtherMVP
NYBB 1663Medicare ID - Type Unspecified
NY318340OtherMVP