Provider Demographics
NPI:1578055521
Name:UHLENHOPP, ALEX JON
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:JON
Last Name:UHLENHOPP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 S PIERCE AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2709
Mailing Address - Country:US
Mailing Address - Phone:641-424-0780
Mailing Address - Fax:641-424-2345
Practice Address - Street 1:422 S PIERCE AVE STE 1
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401
Practice Address - Country:US
Practice Address - Phone:641-424-0780
Practice Address - Fax:641-424-2345
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA091904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist