Healthcare Provider Details

I. General information

NPI: 1477903490
Provider Name (Legal Business Name): ALEXANDRA E SEXTON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

891 WESTMINSTER ST
PROVIDENCE RI
02903-4020
US

IV. Provider business mailing address

891 WESTMINSTER ST
PROVIDENCE RI
02903-4020
US

V. Phone/Fax

Practice location:
  • Phone: 401-331-7850
  • Fax: 401-274-4739
Mailing address:
  • Phone: 401-331-7850
  • Fax: 401-274-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00629
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: