Provider Demographics
NPI:1003125188
Name:BALDWIN, ALEX (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ALEXANDER
Other - Middle Name:W
Other - Last Name:BALDWIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-1789
Mailing Address - Country:US
Mailing Address - Phone:509-493-2020
Mailing Address - Fax:509-493-2023
Practice Address - Street 1:950 E JEWETT BLVD
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-1120
Practice Address - Country:US
Practice Address - Phone:509-493-2020
Practice Address - Fax:509-493-2023
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-06
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60398390152W00000X
OR3493ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR173977Medicare UPIN