Provider Demographics
NPI:1679323026
Name:FIKES, ALICIA
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:FIKES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1168 DESERT OAK PL
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-1220
Mailing Address - Country:US
Mailing Address - Phone:703-965-5047
Mailing Address - Fax:
Practice Address - Street 1:500 N HWY 90 BYP
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2204
Practice Address - Country:US
Practice Address - Phone:520-458-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101004099156FX1800X
FLDO07457156FX1800X
AZLDO-003154156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician