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General NPI Number Information
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NPI Number | 1124689336
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Entity Type | Individual
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Provider Name | ALEXANDRA E GADA OD
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Gender | Female
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Dates
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Enumeration Date | 06/27/2019
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Last Update Date | 09/10/2021
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Provider Practice Location Address
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Address Line | 85 WEST HIGHWAY 22
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City | SANTO DOMINGO
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State | NM
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Zip | 87052-0340
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Country | US
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Telephone | 505-465-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 847 LARKIN AVE
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City | CREVE COEUR
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State | MO
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Zip | 63141-7738
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Country | US
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Telephone | 847-693-6554
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Fax |
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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 | 728
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT.0C03484
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License Number State | CO
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