Provider Demographics
NPI:1114031911
Name:ZIMNICKI, ALICIA T (OD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:T
Last Name:ZIMNICKI
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:36300 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1219
Mailing Address - Country:US
Mailing Address - Phone:248-352-2806
Mailing Address - Fax:313-562-3000
Practice Address - Street 1:36300 SCHOOLCRAFT RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1219
Practice Address - Country:US
Practice Address - Phone:248-352-2806
Practice Address - Fax:313-562-3000
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4901004377152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4901004377OtherLICENSE NUMBER
MIP09490OtherMEDICARE ID TYPE