Provider Demographics
NPI:1134196959
Name:WASMANSKI, ALEXANDRA DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:DAWN
Last Name:WASMANSKI
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 1:852 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1206
Mailing Address - Country:US
Mailing Address - Phone:570-421-3342
Mailing Address - Fax:570-421-8490
Practice Address - Street 1:852 N 9TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1206
Practice Address - Country:US
Practice Address - Phone:570-421-3342
Practice Address - Fax:570-421-8490
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1651152W00000X
PAOEG001121152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U83975Medicare UPIN