MEDICARE: ANASTASIA ALEX MD

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	207W00000X	Ophthalmology Physician	84069	SC
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207W00000X	Ophthalmology Physician	T8164	TX

General Provider Information

NPI Number	:	1497109375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANASTASIA ALEX MD

Provider Business Mailing Address
First Line	:	3200 N MACARTHUR BLVD STE 200
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-4404
Country	:	US
Telephone Number	:	972-258-7979
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 N MACARTHUR BLVD STE 200
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-4404
Country	:	US
Telephone Number	:	972-258-7979
Fax Number	:	972-570-5502

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

Provider Enumeration Date	:	04/18/2016
Last Update Date	:	02/07/2023

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