Provider Demographics
NPI:1326712894
Name:HOGAN, ALEXIS CLAY (OD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:CLAY
Last Name:HOGAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:CATHRYN
Other - Last Name:CLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3118 DONNELL DR
Mailing Address - Street 2:
Mailing Address - City:FORESTVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20747-3203
Mailing Address - Country:US
Mailing Address - Phone:301-735-5600
Mailing Address - Fax:
Practice Address - Street 1:3118 DONNELL DR
Practice Address - Street 2:
Practice Address - City:FORESTVILLE
Practice Address - State:MD
Practice Address - Zip Code:20747-3203
Practice Address - Country:US
Practice Address - Phone:301-735-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VATA2826152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program