Provider Demographics
NPI:1164904611
Name:MUNCY, ALEXANDRA LEE (OD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LEE
Last Name:MUNCY
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 1:1729 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5345
Mailing Address - Country:US
Mailing Address - Phone:910-763-3601
Mailing Address - Fax:910-763-4608
Practice Address - Street 1:1729 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5345
Practice Address - Country:US
Practice Address - Phone:910-763-3601
Practice Address - Fax:910-763-4608
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-31
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2119DT152W00000X
NC2532152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty