Healthcare Provider Details

I. General information

NPI: 1629381769
Provider Name (Legal Business Name): ALEXA S KOJIMA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8885 LADUE RD
SAINT LOUIS MO
63124-2312
US

IV. Provider business mailing address

2126 FRANZ PARK LN
SAINT LOUIS MO
63139-3570
US

V. Phone/Fax

Practice location:
  • Phone: 314-721-2720
  • Fax: 314-725-2685
Mailing address:
  • Phone: 816-809-9609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046010369
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2010020647
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: