Provider Demographics
NPI:1457191108
Name:MANSOUR, SALIM A (OD)
Entity type:Individual
Prefix:
First Name:SALIM
Middle Name:A
Last Name:MANSOUR
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 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-2227
Mailing Address - Country:US
Mailing Address - Phone:508-339-7600
Mailing Address - Fax:508-339-6393
Practice Address - Street 1:1 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-2227
Practice Address - Country:US
Practice Address - Phone:508-339-7600
Practice Address - Fax:508-339-6393
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAOPT5739152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist