Provider Demographics
NPI:1780674325
Name:TENENTES, ALEXANDER ATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ATHAN
Last Name:TENENTES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MS
Other - First Name:ROSE-MARIE
Other - Middle Name:J
Other - Last Name:SANTARCANGELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:168 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05201-1874
Mailing Address - Country:US
Mailing Address - Phone:802-442-2115
Mailing Address - Fax:802-442-2115
Practice Address - Street 1:168 NORTH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:VT
Practice Address - Zip Code:05201-1874
Practice Address - Country:US
Practice Address - Phone:802-442-2115
Practice Address - Fax:802-442-2115
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT926270OtherMVP
VT56764OtherCIGNA
VT0006614Medicaid
VT926270OtherMVP
VT56764OtherCIGNA