Provider Demographics
NPI:1790308872
Name:CONNER, ALESSANDRA KEELY (OD)
Entity Type:Individual
Prefix:DR
First Name:ALESSANDRA
Middle Name:KEELY
Last Name:CONNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 DORSET ST STE 25
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6241
Mailing Address - Country:US
Mailing Address - Phone:802-863-3000
Mailing Address - Fax:802-863-3001
Practice Address - Street 1:100 DORSET ST STE 25
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6241
Practice Address - Country:US
Practice Address - Phone:802-863-3000
Practice Address - Fax:802-863-3001
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030.0133925-EMGY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist