MEDICARE: TRACY NGUYEN SALGADO OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	33728TLG	CA

General Provider Information

NPI Number	:	1740701796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY NGUYEN SALGADO OD

Provider Business Mailing Address
First Line	:	1453 PEACH AVE
Second Line	:
City	:	MANTECA
State	:	CA
Zip	:	95337-9522
Country	:	US
Telephone Number	:	209-640-2509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1039 EL MONTE AVE STE K
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94040-2371
Country	:	US
Telephone Number	:	650-967-0140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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