Provider Demographics
NPI:1679611826
Name:CHEMELEKOV, ALEXANDER ROUSSEV (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:ROUSSEV
Last Name:CHEMELEKOV
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7415 W CHERRY HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-8795
Mailing Address - Country:US
Mailing Address - Phone:480-726-0941
Mailing Address - Fax:480-726-0943
Practice Address - Street 1:1175 S ARIZONA AVE
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-1504
Practice Address - Country:US
Practice Address - Phone:480-726-0941
Practice Address - Fax:480-726-0943
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ44673OtherSPECTERA PROVIDER #