Provider Demographics
NPI:1184355836
Name:O'DONNELL, ALEXANDRA M (OD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:O'DONNELL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:M
Other - Last Name:GORALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1123 AVALON DR
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1092
Mailing Address - Country:US
Mailing Address - Phone:401-651-7109
Mailing Address - Fax:
Practice Address - Street 1:891 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4020
Practice Address - Country:US
Practice Address - Phone:401-331-7850
Practice Address - Fax:401-274-4739
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
RIODTG-00737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program