Provider Demographics
NPI:1366878167
Name:WILLIAMSON, ALEXANDRA KAY HARGENRADER (OD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:KAY HARGENRADER
Last Name:WILLIAMSON
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 1:2022 E 105TH ST EYE BLDG
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-5890
Mailing Address - Fax:216-445-2226
Practice Address - Street 1:2022 E 105TH ST EYE BLDG
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3604
Practice Address - Country:US
Practice Address - Phone:216-444-5890
Practice Address - Fax:216-445-2226
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006837152WP0200X
MI4901004809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics