Provider Demographics
NPI:1124649215
Name:POTTER, ALEXANDRA ELENA (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:ELENA
Last Name:POTTER
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 1:7001 S EDGERTON RD STE B
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-4206
Mailing Address - Country:US
Mailing Address - Phone:405-261-9744
Mailing Address - Fax:
Practice Address - Street 1:7001 S EDGERTON RD STE B
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-4206
Practice Address - Country:US
Practice Address - Phone:440-526-1974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OHOPT.006872152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program