Provider Demographics
NPI:1336160027
Name:SALUS UNIVERSITY
Entity Type:Organization
Organization Name:SALUS UNIVERSITY
Other - Org Name:THE EYE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF CLINICAL OPERATIO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GAAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-276-6070
Mailing Address - Street 1:1200 W GODFREY AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3323
Mailing Address - Country:US
Mailing Address - Phone:215-276-6000
Mailing Address - Fax:215-276-1329
Practice Address - Street 1:1200 W GODFREY AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3323
Practice Address - Country:US
Practice Address - Phone:215-276-6000
Practice Address - Fax:215-276-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053189000OtherKEYSTONE EAST OPHTHALMOLO
PA01628OtherHEALTH PARTNERS PA
PA0005591590030Medicaid
PA026958OtherPA BLUE SHIELD OPTOMETRIC
PA0062163000OtherKEYSTONE EAST OPTOMETRIC
PA1002136OtherMERCY HEALTH PLAN PA
PA132200OtherPA BLUE SHIELD OPHTHALMOL
PA2248OtherAETNA US HEALTHCARE
PA01628OtherHEALTH PARTNERS PA
PA2248OtherAETNA US HEALTHCARE
PA0005591590030Medicaid