Provider Demographics
NPI:1346304813
Name:ALEXANDER, DEANNA SWAFFORD (OD)
Entity Type:Individual
Prefix:DR
First Name:DEANNA
Middle Name:SWAFFORD
Last Name:ALEXANDER
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 1:702 W DRAKE RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-5563
Mailing Address - Country:US
Mailing Address - Phone:970-221-4811
Mailing Address - Fax:970-221-4815
Practice Address - Street 1:702 W DRAKE RD BLDG B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5563
Practice Address - Country:US
Practice Address - Phone:970-221-4811
Practice Address - Fax:970-221-4815
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1341152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0540330001OtherDMERC
CO08013419Medicaid
CO08013419Medicaid
COCF0013Medicare PIN