Provider Demographics
NPI:1427602051
Name:ROWE, ALEXA L (OD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:L
Last Name:ROWE
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 1:2861 TRICOM ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9172
Mailing Address - Country:US
Mailing Address - Phone:843-725-0064
Mailing Address - Fax:843-569-7885
Practice Address - Street 1:2060 CHARLIE HALL BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-6066
Practice Address - Country:US
Practice Address - Phone:843-722-2010
Practice Address - Fax:843-723-3914
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011343152W00000X, 390200000X
SCOPT2228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program