Provider Demographics
NPI:1881858926
Name:WAXLER, ALICIA (OD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:WAXLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10021 LIMA RD
Mailing Address - Street 2:DOCTOR'S EXCHANGE OF INDIANA, PC
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-8904
Mailing Address - Country:US
Mailing Address - Phone:260-416-0869
Mailing Address - Fax:260-416-0873
Practice Address - Street 1:10021 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8904
Practice Address - Country:US
Practice Address - Phone:260-416-0869
Practice Address - Fax:260-416-0873
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist