Healthcare Provider Details

I. General information

NPI: 1558293373
Provider Name (Legal Business Name): ALEXYS KATINA EUCKER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

919 E TURKEYFOOT LAKE RD STE C
GREEN OH
44312-5250
US

IV. Provider business mailing address

919 E TURKEYFOOT LAKE RD STE C
GREEN OH
44312-5250
US

V. Phone/Fax

Practice location:
  • Phone: 330-899-0202
  • Fax:
Mailing address:
  • Phone: 330-899-0202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007500
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: