MEDICARE: SALIM OPTICAL LLC

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	156F00000X	Technician/Technologist	220452
2	261Q00000X	Clinic/Center
3	332H00000X	Eyewear Supplier	220452	MI
4	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1518470855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALIM OPTICAL LLC

Provider Business Mailing Address
First Line	:	2001 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4864
Country	:	US
Telephone Number	:	586-693-5060
Fax Number	:	586-693-5060

Provider Business Practice Location Address
First Line	:	2001 15 MILE RD
Second Line	:
City	:	STERLING HEIGHTS
State	:	MI
Zip	:	48310-4864
Country	:	US
Telephone Number	:	586-693-5060
Fax Number	:	586-693-5060

Authorized Official
Title or Position	:	OWNER
Name	:	SALIM KENETHA
Credential	:
Telephone Number	:	248-835-0496

Provider Enumeration Date	:	11/08/2017
Last Update Date	:	11/07/2022

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Directions to “SALIM OPTICAL LLC ” Practice Location

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