Provider Demographics
NPI:1821301136
Name:VOROBEVA, ALEXANDRA G (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:G
Last Name:VOROBEVA
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 1:14866 OLD SAINT AUGUSTINE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32258-2611
Mailing Address - Country:US
Mailing Address - Phone:904-379-5450
Mailing Address - Fax:904-372-8223
Practice Address - Street 1:14866 OLD SAINT AUGUSTINE RD STE 110
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2611
Practice Address - Country:US
Practice Address - Phone:904-379-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-15
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4592152W00000X
OH6003152W00000X
MI4901004568152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930193Medicare PIN
MIN34040103Medicare PIN