Provider Demographics
NPI:1942740212
Name:AMANN, ALEX
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:AMANN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 CHIPPEWA ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2104
Mailing Address - Country:US
Mailing Address - Phone:314-353-6171
Mailing Address - Fax:314-353-0031
Practice Address - Street 1:6451 CHIPPEWA ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2104
Practice Address - Country:US
Practice Address - Phone:314-353-6171
Practice Address - Fax:314-353-0031
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011080152W00000X
MO2017006443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist