Healthcare Provider Details

I. General information

NPI: 1124079595
Provider Name (Legal Business Name): RALPH HARRY SALISBURY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 UNIVERSITY AVE SUITE D
RIVERSIDE CA
92507-4467
US

IV. Provider business mailing address

1450 UNIVERSITY AVE SUITE D
RIVERSIDE CA
92507-4467
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-8650
  • Fax: 951-276-0312
Mailing address:
  • Phone: 951-788-8650
  • Fax: 951-276-0312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 6108 TPA
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT 6108 TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: