Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPT 6108 TPA | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT 6108 TPA | CA |
NPI | 1124079595 |
---|---|
Provider Name | Dr. Ralph Harry Salisbury |
First Address | Riverside, CA 92507-4467 |
Second Address | Riverside, CA 92507-4467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD0061080 | (05) | CA |
T10234 | (02) | CA |