MEDICARE: DR. ALEXA SOPHIA LORA OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC6758	FL

General Provider Information

NPI Number	:	1023904380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXA SOPHIA LORA OD

Provider Business Mailing Address
First Line	:	4976 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34981-5009
Country	:	US
Telephone Number	:	772-460-8487
Fax Number	:

Provider Business Practice Location Address
First Line	:	4976 S 25TH ST
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34981-5009
Country	:	US
Telephone Number	:	772-460-8487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2025
Last Update Date	:	06/14/2025

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