MEDICARE: JOANNETTE SALAS OD AND ASSOCIATES PA

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPC3633	OTHER	FL	OPTOMETRIST LICENSE

General Provider Information

NPI Number	:	1376297861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOANNETTE SALAS OD AND ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1 HARMON DR
Second Line	:
City	:	BLACKWOOD
State	:	NJ
Zip	:	08012-5103
Country	:	US
Telephone Number	:	856-228-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1311 E MICHIGAN ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32806-4814
Country	:	US
Telephone Number	:	407-843-3533
Fax Number	:

Authorized Official
Title or Position	:	PROFESSIONAL RELATIONS MANAGER
Name	:	MRS. RANDI WOERNER
Credential	:
Telephone Number	:	856-228-1000

Provider Enumeration Date	:	02/04/2022
Last Update Date	:	09/19/2022

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