Provider Demographics
NPI:1871339283
Name:RICE, ALICIA LOUISE (LDO)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:LOUISE
Last Name:RICE
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 LOG CABIN DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31204-6318
Mailing Address - Country:US
Mailing Address - Phone:478-788-7667
Mailing Address - Fax:478-788-7780
Practice Address - Street 1:4701 LOG CABIN DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31204-6318
Practice Address - Country:US
Practice Address - Phone:478-788-7667
Practice Address - Fax:478-788-7780
Is Sole Proprietor?:No
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALDO002690156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician