Provider Demographics
NPI:1275877490
Name:LUMINA OPTOMETRY INCORPORATED
Entity Type:Organization
Organization Name:LUMINA OPTOMETRY INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:SALMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:415-457-2020
Mailing Address - Street 1:35 SAN ANSELMO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANSELMO
Mailing Address - State:CA
Mailing Address - Zip Code:94960-2842
Mailing Address - Country:US
Mailing Address - Phone:415-457-2020
Mailing Address - Fax:415-457-2047
Practice Address - Street 1:35 SAN ANSELMO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANSELMO
Practice Address - State:CA
Practice Address - Zip Code:94960-2842
Practice Address - Country:US
Practice Address - Phone:415-457-2020
Practice Address - Fax:415-457-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9594T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGU762AMedicare PIN