Healthcare Provider Details

I. General information

NPI: 1699801886
Provider Name (Legal Business Name): ALEXANDRA GELT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8009 S 180TH ST STE 104
KENT WA
98032-1042
US

IV. Provider business mailing address

330 SW 43RD ST STE K PMB #163
RENTON WA
98057-4944
US

V. Phone/Fax

Practice location:
  • Phone: 425-251-9200
  • Fax: 425-251-9201
Mailing address:
  • Phone: 425-251-9200
  • Fax: 425-251-9201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00003405
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: