Provider Demographics
NPI:1740562628
Name:ALEXANDRA KEHOE, OD PLLC
Entity Type:Organization
Organization Name:ALEXANDRA KEHOE, OD PLLC
Other - Org Name:PREMIER EYE CENTER OF BOCA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEHOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-482-8300
Mailing Address - Street 1:7840 GLADES RD
Mailing Address - Street 2:SUITE 245
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4102
Mailing Address - Country:US
Mailing Address - Phone:561-482-8300
Mailing Address - Fax:561-482-8381
Practice Address - Street 1:7840 GLADES RD
Practice Address - Street 2:SUITE 245
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4102
Practice Address - Country:US
Practice Address - Phone:561-482-8300
Practice Address - Fax:561-482-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4614152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004090700Medicaid
FLFM037AMedicare UPIN