Provider Demographics
NPI:1205492998
Name:IVES, ALEXA (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:
Last Name:IVES
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 1:4465 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1923
Mailing Address - Country:US
Mailing Address - Phone:724-733-1918
Mailing Address - Fax:
Practice Address - Street 1:4465 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1923
Practice Address - Country:US
Practice Address - Phone:724-733-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PA390200000X
PAOEG003535152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program