Healthcare Provider Details

I. General information

NPI: 1255498838
Provider Name (Legal Business Name): ALAN LAX OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 CENTRAL PARK AVENUE
YONKERS NY
10710-1133
US

IV. Provider business mailing address

2500 CENTRAL PARK AVENUE
YONKERS NY
10710-1133
US

V. Phone/Fax

Practice location:
  • Phone: 914-337-2100
  • Fax: 914-337-2106
Mailing address:
  • Phone: 914-337-2100
  • Fax: 914-337-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT0033731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: