MEDICARE: DR. SALUMEH RASTANI TALAGA O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TA2058	MD
2	152W00000X	Optometrist	OPT13653	CA

General Provider Information

NPI Number	:	1134306574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SALUMEH RASTANI TALAGA O.D.

Provider Business Mailing Address
First Line	:	414 K ST
Second Line	:	C/O LENSCRAFTERS AT MACY'S
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-3304
Country	:	US
Telephone Number	:	916-341-0382
Fax Number	:	916-554-7646

Provider Business Practice Location Address
First Line	:	414 K ST
Second Line	:	C/O LENSCRAFTERS AT MACY'S
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-3304
Country	:	US
Telephone Number	:	916-341-0382
Fax Number	:	916-554-7646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2008
Last Update Date	:	11/15/2016

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