Provider Demographics
NPI:1578825634
Name:ZEMKE, ALEX C (OD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:C
Last Name:ZEMKE
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 1:2290 KIPLING ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1546
Mailing Address - Country:US
Mailing Address - Phone:303-238-9900
Mailing Address - Fax:303-238-8527
Practice Address - Street 1:2290 KIPLING ST UNIT 1
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1546
Practice Address - Country:US
Practice Address - Phone:303-238-9900
Practice Address - Fax:303-238-8527
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-13
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0002973152W00000X
IL046010548152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04023859Medicaid
CO314261YMHWMedicare PIN