Provider Demographics
NPI:1982788030
Name:ALEXANDER, AVERY DELVIN (MD)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:DELVIN
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 KEYES STREET
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952
Mailing Address - Country:US
Mailing Address - Phone:920-751-8492
Mailing Address - Fax:
Practice Address - Street 1:250 N METRO DRIVE
Practice Address - Street 2:ALEXANDER EYE INSTITUTE
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913
Practice Address - Country:US
Practice Address - Phone:920-830-2020
Practice Address - Fax:920-830-1118
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30180207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F05698Medicare UPIN
000147935Medicare ID - Type Unspecified