Provider Demographics
NPI:1710007935
Name:JESSE SALAZAR OD PA
Entity Type:Organization
Organization Name:JESSE SALAZAR OD PA
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-454-0471
Mailing Address - Street 1:3802 JOE RAMSEY BLVD E
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7711
Mailing Address - Country:US
Mailing Address - Phone:903-454-0471
Mailing Address - Fax:903-450-4332
Practice Address - Street 1:3802 JOE RAMSEY BLVD E
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7711
Practice Address - Country:US
Practice Address - Phone:903-454-0471
Practice Address - Fax:903-450-4332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX3683152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
T15705Medicare UPIN
TX5166760001Medicare NSC
TX00715WMedicare ID - Type Unspecified
TX00715WMedicare PIN