MEDICARE: ALEXIS L. LOGAN 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	156FX1202X	Optometric Technician
2	152W00000X	Optometrist	2576	SC

General Provider Information

NPI Number	:	1184585390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS L. LOGAN OD

Provider Business Mailing Address
First Line	:	2120 STATESVILLE BLVD
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28147-1410
Country	:	US
Telephone Number	:	704-636-0559
Fax Number	:

Provider Business Practice Location Address
First Line	:	2427 CROSS POINTE DR
Second Line	:
City	:	ROCK HILL
State	:	SC
Zip	:	29730-8267
Country	:	US
Telephone Number	:	803-681-0973
Fax Number	:

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

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	01/28/2026

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Directions to “ ALEXIS L. LOGAN OD” Practice Location

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