Provider Demographics
NPI:1619281094
Name:SALIB, PEDRO DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:DAVID
Last Name:SALIB
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:LAS FLORES DE MONTEHIEDRA 300
Mailing Address - Street 2:CALLE ROMERILLO BUZON 680
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-708-4444
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPP CTR
Practice Address - Street 2:AVE. FRAGOSO, FIRST FLOOR, LOCAL 108
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-5672
Practice Address - Country:US
Practice Address - Phone:787-708-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRDAVID4444Medicare PIN
PRDAVID4444Medicare UPIN