Provider Demographics
NPI:1629381769
Name:KOJIMA, ALEXA S (OD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:S
Last Name:KOJIMA
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 1:2126 FRANZ PARK LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3570
Mailing Address - Country:US
Mailing Address - Phone:816-809-9609
Mailing Address - Fax:
Practice Address - Street 1:8885 LADUE RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2312
Practice Address - Country:US
Practice Address - Phone:314-721-2720
Practice Address - Fax:314-725-2685
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010369152W00000X
MO2010020647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1595031Medicare PIN