Provider Demographics
NPI:1073244455
Name:HELSLEY, ALEX (OD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:HELSLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471748 E 1140 RD
Mailing Address - Street 2:
Mailing Address - City:MULDROW
Mailing Address - State:OK
Mailing Address - Zip Code:74948-7594
Mailing Address - Country:US
Mailing Address - Phone:918-208-4207
Mailing Address - Fax:
Practice Address - Street 1:471748 E 1140 RD
Practice Address - Street 2:
Practice Address - City:MULDROW
Practice Address - State:OK
Practice Address - Zip Code:74948-7594
Practice Address - Country:US
Practice Address - Phone:918-208-4207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3172152W00000X
AR2851152W00000X
AR390200000X
MO2022024935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program