Provider Demographics
NPI:1669452447
Name:SATANOSKY, SELMO (OD)
Entity Type:Individual
Prefix:DR
First Name:SELMO
Middle Name:
Last Name:SATANOSKY
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 1:6788 TAFT STREET
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024
Mailing Address - Country:US
Mailing Address - Phone:954-981-1450
Mailing Address - Fax:954-981-1451
Practice Address - Street 1:6788 TAFT STREET
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024
Practice Address - Country:US
Practice Address - Phone:954-981-1450
Practice Address - Fax:954-981-1451
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP1454152W00000X
FLOPC1454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620277200Medicaid
FLID620277200Medicaid
FLU22773Medicare UPIN
FLID620277200Medicaid
FLEZ889AMedicare PIN
FL620277200Medicaid