Provider Demographics
NPI:1922759851
Name:SALAZAR, MICHAEL LEE JR
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:SALAZAR
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 NE LOOP 410 STE D304
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-1408
Mailing Address - Country:US
Mailing Address - Phone:210-225-5393
Mailing Address - Fax:210-444-9225
Practice Address - Street 1:900 NE LOOP 410 STE D304
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1408
Practice Address - Country:US
Practice Address - Phone:210-225-5393
Practice Address - Fax:210-444-9225
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens