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General NPI Number Information
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NPI Number | 1053978361
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Entity Type | Individual
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Provider Name | ALEXZANDRA RUDINOFF ROTH OD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2019
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 2311 HAYES AVE SUITE B
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City | FREMONT
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State | OH
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Zip | 43420-2634
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Country | US
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Telephone | 419-334-8121
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Fax | 419-332-9351
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Provider Business Mailing Address
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Address Line | 2311 HAYES AVE SUITE B
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City | FREMONT
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State | OH
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Zip | 43420-2634
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Country | US
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Telephone | 419-334-8121
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Fax | 419-332-9351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT.006777
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License Number State | OH
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