Provider Demographics
NPI:1942832183
Name:COON, ALEXANDRA JORDAN LOUISE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:JORDAN LOUISE
Last Name:COON
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 1:935 E WESTPOINT DR STE 207
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7181
Mailing Address - Country:US
Mailing Address - Phone:907-373-0225
Mailing Address - Fax:
Practice Address - Street 1:935 E WESTPOINT DR STE 207
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7181
Practice Address - Country:US
Practice Address - Phone:907-373-0225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-05
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK153275152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist