Basic Information
| Provider Information | |||||||||
| NPI: | 1972555001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALDIVIA | ||||||||
| FirstName: | MARCELO | ||||||||
| MiddleName: | ADRIAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 E PROSPECT ROAD | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805251307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702212222 | ||||||||
| FaxNumber: | 9702212223 | ||||||||
| Practice Location | |||||||||
| Address1: | 326 DOZIER AVE | ||||||||
| Address2: | |||||||||
| City: | CANON CITY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812122706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7192760344 | ||||||||
| FaxNumber: | 7192697446 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2006 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 2502 | CO | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 28402065 | 05 | CO | MEDICAID | P00412475 | 01 | CO | RAIL ROAD MEDICARE PTAN | OTHER | 2622905 | 01 | CO | CIGNA | OTHER |