Provider Demographics
NPI:1780178657
Name:WISS, ALEXANDRIA RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:RENEE
Last Name:WISS
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 1:40W770 STONECREST DR
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60124-8171
Mailing Address - Country:US
Mailing Address - Phone:630-624-5239
Mailing Address - Fax:
Practice Address - Street 1:7400 E ORCHARD RD STE 175-S
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2631
Practice Address - Country:US
Practice Address - Phone:303-850-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0003387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist