Provider Demographics
NPI:1558987644
Name:KORTSEN, LEXI TAYLOR (OD)
Entity Type:Individual
Prefix:
First Name:LEXI
Middle Name:TAYLOR
Last Name:KORTSEN
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 1:1600 W UNIVERSITY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3154
Mailing Address - Country:US
Mailing Address - Phone:928-240-9214
Mailing Address - Fax:928-240-9212
Practice Address - Street 1:900 N SAN FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3236
Practice Address - Country:US
Practice Address - Phone:928-779-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002429152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist