Provider Demographics
NPI:1568816635
Name:CONLEY, ALEX (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 N RIVERSIDE DR UNIT 130
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76137-6664
Mailing Address - Country:US
Mailing Address - Phone:817-928-3337
Mailing Address - Fax:817-928-3337
Practice Address - Street 1:6060 AZLE AVE STE 500
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2612
Practice Address - Country:US
Practice Address - Phone:817-546-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9337TG152WV0400X
OK2879152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist