Provider Demographics
NPI:1285684761
Name:SALAK, GARY F (OD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:F
Last Name:SALAK
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 1:236 EDGEFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ARIEL
Mailing Address - State:PA
Mailing Address - Zip Code:18436-4628
Mailing Address - Country:US
Mailing Address - Phone:570-698-1175
Mailing Address - Fax:
Practice Address - Street 1:322 BROAD ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-1345
Practice Address - Country:US
Practice Address - Phone:570-296-4891
Practice Address - Fax:570-296-4892
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000082152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA819706OtherFIRST PRIORITY HEALTH
PAZA1816976OtherHIGHMARK BLUESHIELD
PAU63460Medicare UPIN