Provider Demographics
NPI:1518470855
Name:SALIM OPTICAL LLC
Entity Type:Organization
Organization Name:SALIM OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KENETHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-835-0496
Mailing Address - Street 1:2001 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4864
Mailing Address - Country:US
Mailing Address - Phone:586-693-5060
Mailing Address - Fax:586-693-5060
Practice Address - Street 1:2001 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48310-4864
Practice Address - Country:US
Practice Address - Phone:586-693-5060
Practice Address - Fax:586-693-5060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
220452156F00000X
207W00000X, 261Q00000X
MI220452332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No156F00000XEye and Vision Services ProvidersTechnician/TechnologistGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No332H00000XSuppliersEyewear SupplierGroup - Multi-Specialty