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NPI Code Detail

MEDICARE: DR. COSMO SALIBELLO O.D.

MEDICARE: DR. COSMO SALIBELLO 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
1152W00000XOptometrist1658 ATIOR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1212994OTHERORHEALTH NET ID NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1942307533
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COSMO SALIBELLO O.D.
Provider Business Mailing Address
First Line : 9898 SW LYNWOOD TER
Second Line :
City : PORTLAND
State : OR
Zip : 97225-4341
Country : US
Telephone Number : 503-296-7655
Fax Number : 503-296-7655
Provider Business Practice Location Address
First Line : 23500 NE SANDY BLVD
Second Line : LOCATED INSIDE WALMART
City : WOOD VILLAGE
State : OR
Zip : 97060-9653
Country : US
Telephone Number : 503-667-8869
Fax Number : 503-667-7598
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/17/2006
Last Update Date : 07/09/2007

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Directions to “ DR. COSMO SALIBELLO O.D.” Practice Location

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