MEDICARE: DR. ALEXANDRA JO CAVIN NILSEN O.D.

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	0618000764	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	194051	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1447296728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDRA JO CAVIN NILSEN O.D.

Provider Business Mailing Address
First Line	:	601 N COURTHOUSE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23236-4062
Country	:	US
Telephone Number	:	804-858-2020
Fax Number	:	804-423-9090

Provider Business Practice Location Address
First Line	:	601 N COURTHOUSE RD
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23236-4062
Country	:	US
Telephone Number	:	804-858-2020
Fax Number	:	804-423-9090

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	11/03/2008

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