Provider Demographics
NPI:1912740549
Name:TAYLOR, ALICIA (OD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11045 GENEVA SOUND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5474
Mailing Address - Country:US
Mailing Address - Phone:214-326-6542
Mailing Address - Fax:
Practice Address - Street 1:11045 GENEVA SOUND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-5474
Practice Address - Country:US
Practice Address - Phone:214-326-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist