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General NPI Number Information
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NPI Number | 1588844252
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Entity Type | Organization
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Legal Business Name | SALEM VISION CENTER INC
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Dates
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Enumeration Date | 11/09/2007
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 25130 75TH ST
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City | SALEM
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State | WI
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Zip | 53168-9661
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Country | US
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Telephone | 262-843-1513
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Fax | 262-843-1404
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Provider Business Mailing Address
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Address Line | 25130 75TH ST
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City | SALEM
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State | WI
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Zip | 53168-9661
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Country | US
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Telephone | 262-843-1513
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Fax | 262-843-1404
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. PETER JOSEPH KALINKA
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Credential | O.D.
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Telephone | 262-843-1513
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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 | 2306-035
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License Number State | WI
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