Provider Demographics
NPI:1407932288
Name:ALEXANDER, MICHAEL SEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:SEAN
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5315 WINDWARD PKWY
Mailing Address - Street 2:STE F
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8915
Mailing Address - Country:US
Mailing Address - Phone:678-393-2025
Mailing Address - Fax:678-393-0020
Practice Address - Street 1:5315 WINDWARD PKWY
Practice Address - Street 2:STE F
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-8915
Practice Address - Country:US
Practice Address - Phone:678-393-2025
Practice Address - Fax:678-393-0020
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1542152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU70443Medicare UPIN
GA41ZCFBSMedicare ID - Type Unspecified