Provider Demographics
NPI:1891318093
Name:HUTZELL, ALEXANDRIA SHANNON (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:SHANNON
Last Name:HUTZELL
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 1:2424 SHASTA WAY
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-4354
Mailing Address - Country:US
Mailing Address - Phone:541-882-2812
Mailing Address - Fax:
Practice Address - Street 1:2424 SHASTA WAY
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-4354
Practice Address - Country:US
Practice Address - Phone:541-882-2812
Practice Address - Fax:541-882-5075
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORATI4500152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist