Healthcare Provider Details

I. General information

NPI: 1699482760
Provider Name (Legal Business Name): ALEXANDRA JAYNE STEVENS OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA J STEVENS OD

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

703 RUTTER AVE
KINGSTON PA
18704-4801
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 570-288-7405
  • Fax:
Mailing address:
  • Phone: 570-288-7405
  • Fax: 570-288-7406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: