Provider Demographics
NPI:1720022916
Name:SALMENSON, HERMAN (OD)
Entity Type:Individual
Prefix:MR
First Name:HERMAN
Middle Name:
Last Name:SALMENSON
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 1:9875 MEDLOCK BRIDGE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-6640
Mailing Address - Country:US
Mailing Address - Phone:770-813-0026
Mailing Address - Fax:770-813-0029
Practice Address - Street 1:9875 MEDLOCK BRIDGE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-813-0026
Practice Address - Fax:770-813-0029
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00319514Medicaid
U49232Medicare UPIN
GA00319514Medicaid