1659386241 NPI number — ALEXA RAWLINGS LUPFER OD

Table of content: ALEXA RAWLINGS LUPFER OD (NPI 1659386241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659386241 NPI number — ALEXA RAWLINGS LUPFER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUPFER
Provider First Name:
ALEXA
Provider Middle Name:
RAWLINGS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAWLINGS
Provider Other First Name:
ALEXA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659386241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16525 BIRKDALE COMMONS PKWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HUNTERSVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28078
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-896-3311
Provider Business Mailing Address Fax Number:
704-896-5514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16525 BIRKDALE COMMONS PKWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
HUNTERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28078
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-896-3311
Provider Business Practice Location Address Fax Number:
704-896-5514
Provider Enumeration Date:
07/30/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  NC 1957 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 371457054 . This is a "SUPERIOR VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2473992 , issued by the state of ( NC ) . This identifiers is of the category "MEDICARE ID-TYPE UNSPECIFIED".
  • Identifier: 093TN . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 093TN . This is a "NC HEALTH CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: V09196 . This identifiers is of the category "MEDICARE UPIN".