Provider Demographics
NPI:1689160194
Name:BOUNKHONG, ALEXIA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIA
Middle Name:
Last Name:BOUNKHONG
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 1:850 S DAHLIA CIRCLE
Mailing Address - Street 2:APT F105
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246
Mailing Address - Country:US
Mailing Address - Phone:479-463-0663
Mailing Address - Fax:
Practice Address - Street 1:850 S DAHLIA CIRCLE
Practice Address - Street 2:APT F105
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246
Practice Address - Country:US
Practice Address - Phone:479-463-0663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT.0003405152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist