Provider Demographics
NPI:1003814088
Name:MUSUMECI, SALVATORE (OD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:MUSUMECI
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 1:9375 66TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-4418
Mailing Address - Country:US
Mailing Address - Phone:727-541-4469
Mailing Address - Fax:727-546-9661
Practice Address - Street 1:9375 66TH ST N
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-4418
Practice Address - Country:US
Practice Address - Phone:727-541-4469
Practice Address - Fax:727-546-9661
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20237OtherBLUE CROSS BLUE SHIELD
FL078911900Medicaid
FL4418042OtherAETNA PROVIDER #
FL20237OtherBLUE CROSS BLUE SHIELD