Provider Demographics
NPI:1538142302
Name:DE CANIO, SALVATORE (OD, FAAO)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:
Last Name:DE CANIO
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 CYPRESS KEY CIR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1234
Mailing Address - Country:US
Mailing Address - Phone:561-665-0437
Mailing Address - Fax:561-721-0714
Practice Address - Street 1:798 NEAPOLITAN WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-8504
Practice Address - Country:US
Practice Address - Phone:239-649-1011
Practice Address - Fax:561-734-2847
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-24
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEFL OPC1598152W00000X
FLFL OPC001598152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL OPC1598OtherSTATE OPTOMETRY LICENSE#
FL078200900Medicaid
FL078200901Medicaid
FLT84132Medicare UPIN
FL19495XMedicare PIN