Healthcare Provider Details

I. General information

NPI: 1346304813
Provider Name (Legal Business Name): DEANNA SWAFFORD ALEXANDER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 W DRAKE RD BLDG B
FORT COLLINS CO
80526-5563
US

IV. Provider business mailing address

702 W DRAKE RD BLDG B
FORT COLLINS CO
80526-5563
US

V. Phone/Fax

Practice location:
  • Phone: 970-221-4811
  • Fax: 970-221-4815
Mailing address:
  • Phone: 970-221-4811
  • Fax: 970-221-4815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number1341
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1341
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0540330001
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerDMERC
# 2
Identifier08013419
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: