Provider Demographics
NPI:1346920980
Name:VAN VOLKENBURG, LEXA (OD)
Entity Type:Individual
Prefix:DR
First Name:LEXA
Middle Name:
Last Name:VAN VOLKENBURG
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 1:185 W ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-2569
Mailing Address - Country:US
Mailing Address - Phone:541-391-3682
Mailing Address - Fax:
Practice Address - Street 1:341 NW MEDICAL LOOP STE 120
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-5546
Practice Address - Country:US
Practice Address - Phone:541-672-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT4696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist