Provider Demographics
NPI:1316995251
Name:ALEXANDER, SUNAH KIM (OD)
Entity type:Individual
Prefix:DR
First Name:SUNAH
Middle Name:KIM
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1783 US-9
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065
Mailing Address - Country:US
Mailing Address - Phone:518-782-7827
Mailing Address - Fax:518-782-7820
Practice Address - Street 1:713 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 135
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2490
Practice Address - Country:US
Practice Address - Phone:518-782-7827
Practice Address - Fax:518-782-7820
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000000005848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10029632OtherCDPHP
NY000406323002OtherBLUE SHIELD NENY
NYC395EOtherBLUE CROSS/BLUE SHIELD
NY371959OtherMVP
NYRA6224Medicare ID - Type Unspecified
NY000406323002OtherBLUE SHIELD NENY