Provider Demographics
NPI:1992848071
Name:SCATCHELL, ALEXANDRIA E (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:E
Last Name:SCATCHELL
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 1:6307 N MINNEHAHA AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-4120
Mailing Address - Country:US
Mailing Address - Phone:773-458-3230
Mailing Address - Fax:
Practice Address - Street 1:4151 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-6002
Practice Address - Country:US
Practice Address - Phone:773-685-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.9919152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046.9919Medicaid