Provider Demographics
NPI:1124247523
Name:HARRISON-SICRE, ALICIA MICHELLE (OD)
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:MICHELLE
Last Name:HARRISON-SICRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:MICHELLE
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1100 S COAST HWY
Mailing Address - Street 2:STE 201
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2968
Mailing Address - Country:US
Mailing Address - Phone:949-497-1769
Mailing Address - Fax:949-497-2808
Practice Address - Street 1:1100 S COAST HWY
Practice Address - Street 2:STE 201
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2968
Practice Address - Country:US
Practice Address - Phone:949-497-1769
Practice Address - Fax:949-497-2808
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11495TPL152W00000X
CA11495TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92747Medicare UPIN