Provider Demographics
NPI:1033838032
Name:KLEINKORT, ALEXANDRA PAIGE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:PAIGE
Last Name:KLEINKORT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4137 BROOKSIDE MESA VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-4495
Mailing Address - Country:US
Mailing Address - Phone:719-237-3580
Mailing Address - Fax:
Practice Address - Street 1:9320 GRAND CORDERA PKWY STE 255
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7021
Practice Address - Country:US
Practice Address - Phone:719-258-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist