Basic Information
| Provider Information | |||||||||
| NPI: | 1164904611 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MUNCY | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | O.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1729 NEW HANOVER MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284035345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107633601 | ||||||||
| FaxNumber: | 9107634608 | ||||||||
| Practice Location | |||||||||
| Address1: | 1729 NEW HANOVER MEDICAL PARK DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284035345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9107633601 | ||||||||
| FaxNumber: | 9107634608 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2018 | ||||||||
| LastUpdateDate: | 10/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2119DT | KY | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 152W00000X | 2532 | NC | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.