Healthcare Provider Details

I. General information

NPI: 1184585390
Provider Name (Legal Business Name): ALEXIS L. LOGAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2427 CROSS POINTE DR
ROCK HILL SC
29730-8267
US

IV. Provider business mailing address

2120 STATESVILLE BLVD
SALISBURY NC
28147-1410
US

V. Phone/Fax

Practice location:
  • Phone: 803-681-0973
  • Fax:
Mailing address:
  • Phone: 704-636-0559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1202X
TaxonomyOptometric Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2576
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: