Healthcare Provider Details

I. General information

NPI: 1356570907
Provider Name (Legal Business Name): GRACE SALONE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRACE MORANO-SALONE OD

II. Dates (important events)

Enumeration Date: 07/03/2009
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W UNIVERSITY AVE STE 108
GEORGETOWN TX
78626
US

IV. Provider business mailing address

950 W UNIVERSITY AVE STE 108
GEORGETOWN TX
78626-6505
US

V. Phone/Fax

Practice location:
  • Phone: 512-240-5862
  • Fax: 866-512-1070
Mailing address:
  • Phone: 512-240-5862
  • Fax: 866-512-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number7524TG
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7524TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: