Basic Information
| Provider Information | |||||||||
| NPI: | 1629381769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOJIMA | ||||||||
| FirstName: | ALEXA | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2126 FRANZ PARK LN | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631393570 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8168099609 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8885 LADUE RD | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631242312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3147212720 | ||||||||
| FaxNumber: | 3147252685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2010 | ||||||||
| LastUpdateDate: | 11/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 046010369 | IL | N | Eye and Vision Services Providers | Optometrist | 152W00000X | 2010020647 | MO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.