Basic Information
| Provider Information | |||||||||
| NPI: | 1124113162 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALVATORE | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 BRANDT DR. | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CRANBERRY TWP. | ||||||||
| State: | PA | ||||||||
| PostalCode: | 160666412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7247725420 | ||||||||
| FaxNumber: | 7247725423 | ||||||||
| Practice Location | |||||||||
| Address1: | 709 LONG POINT RD STE C | ||||||||
| Address2: | |||||||||
| City: | MT PLEASANT | ||||||||
| State: | SC | ||||||||
| PostalCode: | 294648287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8438490800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 09/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1935 | SC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 101446321 | 05 | PA | MEDICAID | 1764972 | 01 | PA | HIGHMARK BS | OTHER |