Provider Demographics
NPI:1437240215
Name:BAHL, ALEXANDRIA (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRIA
Middle Name:
Last Name:BAHL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 EASTPARK WAY
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2064
Mailing Address - Country:US
Mailing Address - Phone:205-529-5007
Mailing Address - Fax:
Practice Address - Street 1:1309 HIGHWAY 35 S
Practice Address - Street 2:
Practice Address - City:FOREST
Practice Address - State:MS
Practice Address - Zip Code:39074-5010
Practice Address - Country:US
Practice Address - Phone:601-469-5656
Practice Address - Fax:601-469-5656
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002313152W00000X
MS757152W00000X
CA13077152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist