Provider Demographics
NPI:1124113162
Name:SALVATORE, PAUL M (OD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:SALVATORE
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 1:105 BRANDT DR.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CRANBERRY TWP.
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6412
Mailing Address - Country:US
Mailing Address - Phone:724-772-5420
Mailing Address - Fax:724-772-5423
Practice Address - Street 1:709 LONG POINT RD STE C
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-8287
Practice Address - Country:US
Practice Address - Phone:843-849-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-339152W00000X
GAOPT003370152W00000X
SC1935152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101446321Medicaid
PA1764972OtherHIGHMARK BS
PA1764972OtherHIGHMARK BS