Provider Demographics
NPI:1891277760
Name:SALAZAR EYECARE LLC
Entity type:Organization
Organization Name:SALAZAR EYECARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OD
Authorized Official - Prefix:
Authorized Official - First Name:JOSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-219-4123
Mailing Address - Street 1:2883 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-5412
Mailing Address - Country:US
Mailing Address - Phone:407-219-4123
Mailing Address - Fax:407-210-7400
Practice Address - Street 1:2883 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-5412
Practice Address - Country:US
Practice Address - Phone:407-219-4123
Practice Address - Fax:407-210-7400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-06
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty