Healthcare Provider Details

I. General information

NPI: 1447875463
Provider Name (Legal Business Name): ALEXANDRA KATHRYN EDMUND OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALEXANDRA KATHRYN BUDD

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 RIVERSIDE DR
SHELTON CT
06484-8164
US

IV. Provider business mailing address

47 LAKEVIEW DR
RIVERHEAD NY
11901-3428
US

V. Phone/Fax

Practice location:
  • Phone: 203-924-2175
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number003165
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: