Provider Demographics
NPI:1720519002
Name:PIPER, ALEXANDRA M
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:M
Last Name:PIPER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N HAMMES AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-8136
Mailing Address - Country:US
Mailing Address - Phone:815-744-2020
Mailing Address - Fax:
Practice Address - Street 1:370 HOUBOLT RD
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60431-8303
Practice Address - Country:US
Practice Address - Phone:815-729-9143
Practice Address - Fax:815-729-1580
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist