Healthcare Provider Details

I. General information

NPI: 1518470855
Provider Name (Legal Business Name): SALIM OPTICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 15 MILE RD
STERLING HEIGHTS MI
48310-4864
US

IV. Provider business mailing address

2001 15 MILE RD
STERLING HEIGHTS MI
48310-4864
US

V. Phone/Fax

Practice location:
  • Phone: 586-693-5060
  • Fax: 586-693-5060
Mailing address:
  • Phone: 586-693-5060
  • Fax: 586-693-5060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number220452
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number220452
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SALIM KENETHA
Title or Position: OWNER
Credential:
Phone: 248-835-0496