Provider Demographics
NPI:1760451496
Name:PHO, SALENA (OD)
Entity Type:Individual
Prefix:DR
First Name:SALENA
Middle Name:
Last Name:PHO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CAMPBELL ACRES RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77328-8518
Mailing Address - Country:US
Mailing Address - Phone:314-800-7093
Mailing Address - Fax:800-432-6004
Practice Address - Street 1:21550 MARKET PLACE DR STE 200
Practice Address - Street 2:
Practice Address - City:NEW CANEY
Practice Address - State:TX
Practice Address - Zip Code:77357-1726
Practice Address - Country:US
Practice Address - Phone:314-800-7093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001017131152W00000X
TX10425T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410048090OtherRR MEDICARE
MOP00403031OtherRR MEDICARE
675467OtherHEALTHLINK
MO315904912Medicaid
25344OtherUNITED HEALTHCARE
U89513OtherMERCY HEALTH PLANS
156153OtherBLUE CROSS BLUE SHIELD MO
MO315904904Medicaid
MO39566OtherHEALTHCARE USA
MO7131OtherEYEMED
204563OtherCOLE
25344OtherOPTICARE MED. COMPLETE
25344OtherOPTICARE MED. COMPLETE
MOU89513Medicare UPIN
MO315904904Medicaid