Healthcare Provider Details

I. General information

NPI: 1932355187
Provider Name (Legal Business Name): ALEXIS G. MALKIN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 COMMONWEALTH AVE
BOSTON MA
02215-1274
US

IV. Provider business mailing address

424 BEACON ST
BOSTON MA
02115-1129
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-2020
  • Fax:
Mailing address:
  • Phone: 617-262-2030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2134
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPT5080
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: