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General NPI Number Information
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NPI Number | 1629381769
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Entity Type | Individual
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Provider Name | ALEXA S KOJIMA O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/19/2010
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 8885 LADUE RD
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City | SAINT LOUIS
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State | MO
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Zip | 63124-2312
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Country | US
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Telephone | 314-721-2720
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Fax | 314-725-2685
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Provider Business Mailing Address
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Address Line | 2126 FRANZ PARK LN
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City | SAINT LOUIS
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State | MO
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Zip | 63139-3570
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Country | US
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Telephone | 816-809-9609
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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 | 046010369
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License Number State | IL
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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 | 2010020647
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License Number State | MO
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