MEDICARE: MR. MICHAEL LEE SALAZAR JR.

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	156FC0800X	Contact Lens Technician/Technologist

General Provider Information

NPI Number	:	1922759851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL LEE SALAZAR JR.

Provider Business Mailing Address
First Line	:	900 NE LOOP 410 STE D304
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1408
Country	:	US
Telephone Number	:	210-225-5393
Fax Number	:	210-444-9225

Provider Business Practice Location Address
First Line	:	900 NE LOOP 410 STE D304
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1408
Country	:	US
Telephone Number	:	210-225-5393
Fax Number	:	210-444-9225

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

Provider Enumeration Date	:	01/12/2022
Last Update Date	:	03/29/2024

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