Provider Demographics
NPI:1235275009
Name:ALEXEJUN, ROBERT JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:ALEXEJUN
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 1:205 W BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3000
Mailing Address - Country:US
Mailing Address - Phone:715-848-2020
Mailing Address - Fax:715-845-6669
Practice Address - Street 1:205 W BRIDGE ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3000
Practice Address - Country:US
Practice Address - Phone:715-848-2020
Practice Address - Fax:715-845-6669
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4145690001OtherNSC EYE WEAR DESIGNS LLP
WI4900830001OtherNSC EYECARE CTR OF WAUSAU
WI38573100Medicaid
WIT61347Medicare UPIN
WI6210500001Medicare NSC
WI4145690001OtherNSC EYE WEAR DESIGNS LLP