Provider Demographics
NPI:1063476166
Name:ALEXANDER, JOHN C (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
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 1:426 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-1317
Mailing Address - Country:US
Mailing Address - Phone:814-724-2700
Mailing Address - Fax:814-724-2705
Practice Address - Street 1:830 MARKET ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3314
Practice Address - Country:US
Practice Address - Phone:814-724-2700
Practice Address - Fax:814-724-2705
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005458230001Medicaid
0189480001Medicare NSC
003141K86Medicare PIN
PA0005458230001Medicaid