Provider Demographics
NPI:1699482760
Name:STEVENS, ALEXANDRA JAYNE (OD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:JAYNE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:S
Other - Last Name:JAYNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:8530 N 22ND AVE APT 1117
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-6029
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2002 E CAMELBACK RD STE 101
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4784
Practice Address - Country:US
Practice Address - Phone:027-306-9386
Practice Address - Fax:602-840-3431
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZOPT-002646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist