MEDICARE: DR. SONIA SALAS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	13885	CA
2	152W00000X	Optometrist	2012025596	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	12057226	OTHER	MO	CAQH

General Provider Information

NPI Number	:	1114254281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SONIA SALAS O.D.

Provider Business Mailing Address
First Line	:	PO BOX 207158
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75320-7158
Country	:	US
Telephone Number	:	636-200-4393
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N EUCLID AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63108-1601
Country	:	US
Telephone Number	:	314-367-1848
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	03/03/2020

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Directions to “ DR. SONIA SALAS O.D.” Practice Location

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