Provider Demographics
NPI:1548841125
Name:ALIC, SALMEDINA (OD)
Entity type:Individual
Prefix:
First Name:SALMEDINA
Middle Name:
Last Name:ALIC
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 1:320 BAYLESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-1519
Mailing Address - Country:US
Mailing Address - Phone:314-306-0426
Mailing Address - Fax:
Practice Address - Street 1:75 SHELL ST
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571-2202
Practice Address - Country:US
Practice Address - Phone:251-990-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-315-TA-C79152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist