Provider Demographics
NPI:1447296728
Name:NILSEN, ALEXANDRA JO CAVIN (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:JO CAVIN
Last Name:NILSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:JO
Other - Last Name:CAVIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:601 N COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4062
Mailing Address - Country:US
Mailing Address - Phone:804-858-2020
Mailing Address - Fax:804-423-9090
Practice Address - Street 1:601 N COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4062
Practice Address - Country:US
Practice Address - Phone:804-858-2020
Practice Address - Fax:804-423-9090
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA194051OtherANTHEM
VA014863O72Medicare PIN