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General NPI Number Information
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NPI Number | 1568708105
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Entity Type | Organization
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Legal Business Name | GRACE M SALONE, OD, PLLC
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Dates
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Enumeration Date | 01/01/2013
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 950 W UNIVERSITY AVE STE 108
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City | GEORGETOWN
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State | TX
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Zip | 78626
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Country | US
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Telephone | 512-240-5862
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Fax | 866-512-1070
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Provider Business Mailing Address
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Address Line | 950 W UNIVERSITY AVE STE 108
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City | GEORGETOWN
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State | TX
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Zip | 78626-6505
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Country | US
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Telephone | 512-240-5862
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Fax | 866-512-1070
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. GRACE SALONE
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Credential | O.D.
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Telephone | 512-240-5862
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7524TG
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License Number State | TX
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