Provider Demographics
NPI:1184010134
Name:SALEK, TERRENCE EDWARD (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:EDWARD
Last Name:SALEK
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWOYERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18704-1318
Mailing Address - Country:US
Mailing Address - Phone:570-287-2748
Mailing Address - Fax:570-287-5240
Practice Address - Street 1:1200 MAIN ST
Practice Address - Street 2:
Practice Address - City:SWOYERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18704-1318
Practice Address - Country:US
Practice Address - Phone:570-287-2748
Practice Address - Fax:570-287-5240
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000000836156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician