Provider Demographics
NPI:1124079595
Name:SALISBURY, RALPH HARRY (OD)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:HARRY
Last Name:SALISBURY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 UNIVERSITY AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4467
Mailing Address - Country:US
Mailing Address - Phone:951-788-8650
Mailing Address - Fax:951-276-0312
Practice Address - Street 1:1450 UNIVERSITY AVE
Practice Address - Street 2:SUITE D
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4467
Practice Address - Country:US
Practice Address - Phone:951-788-8650
Practice Address - Fax:951-276-0312
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 6108 TPA152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0061080Medicaid
CASD0061080Medicaid
CASD0061080Medicare ID - Type Unspecified