Provider Demographics
NPI:1043780141
Name:CORWIN, ALEXANDRA (OD (OPTOMETRIST))
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:
Last Name:CORWIN
Suffix:
Gender:F
Credentials:OD (OPTOMETRIST)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 W SAN MATEO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4027
Mailing Address - Country:US
Mailing Address - Phone:505-699-6061
Mailing Address - Fax:
Practice Address - Street 1:3811 CERRILLOS RD STE 103
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4150
Practice Address - Country:US
Practice Address - Phone:505-989-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOPT381152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist