Provider Demographics
NPI:1275535825
Name:PALMER, ALECIA R (OD)
Entity Type:Individual
Prefix:DR
First Name:ALECIA
Middle Name:R
Last Name:PALMER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3733 PARK EAST DR
Mailing Address - Street 2:SUITE #104
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4338
Mailing Address - Country:US
Mailing Address - Phone:216-839-0200
Mailing Address - Fax:216-839-0808
Practice Address - Street 1:805 LANCASTER BYP W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-4773
Practice Address - Country:US
Practice Address - Phone:803-238-2603
Practice Address - Fax:803-238-2603
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4934152W00000X
SC1859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDP1859Medicaid
OH0857583Medicare ID - Type Unspecified