Healthcare Provider Details

I. General information

NPI: 1174909923
Provider Name (Legal Business Name): ALEXANDRA LEVASHVILI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2015
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12647 W SMOKEY DR STE 116
SURPRISE AZ
85378-3799
US

IV. Provider business mailing address

12647 W SMOKEY DR STE 116
SURPRISE AZ
85378-3799
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-0377
  • Fax: 623-583-0377
Mailing address:
  • Phone: 623-583-0377
  • Fax: 623-583-0377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG002963
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: