Healthcare Provider Details

I. General information

NPI: 1538142302
Provider Name (Legal Business Name): SALVATORE DE CANIO O.D., F.A.A.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2005
Last Update Date: 05/17/2023
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

798 NEAPOLITAN WAY
NAPLES FL
34103-8504
US

IV. Provider business mailing address

628 CYPRESS KEY CIR
ATLANTIS FL
33462-1234
US

V. Phone/Fax

Practice location:
  • Phone: 239-649-1011
  • Fax: 561-734-2847
Mailing address:
  • Phone: 561-665-0437
  • Fax: 561-721-0714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberFL OPC1598
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberFL OPC001598
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: