Provider Demographics
NPI:1972027894
Name:HORNE, ALEXANDRA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:LEE
Last Name:HORNE
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 1:415 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1343
Mailing Address - Country:US
Mailing Address - Phone:304-872-5678
Mailing Address - Fax:
Practice Address - Street 1:651 WATER ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-1454
Practice Address - Country:US
Practice Address - Phone:304-872-5678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2086-IOD152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2086-IODOtherSTATE LICENSE