Healthcare Provider Details

I. General information

NPI: 1114254281
Provider Name (Legal Business Name): SONIA SALAS O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2009
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N EUCLID AVE
SAINT LOUIS MO
63108-1601
US

IV. Provider business mailing address

PO BOX 207158
DALLAS TX
75320-7158
US

V. Phone/Fax

Practice location:
  • Phone: 314-367-1848
  • Fax:
Mailing address:
  • Phone: 636-200-4393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13885
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2012025596
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: