Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC2248 | FL |
NPI | 1003814088 |
---|---|
Provider Name | Salvatore Musumeci |
First Address | Pinellas Park, FL 33782-4418 |
Second Address | Pinellas Park, FL 33782-4418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 24/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078911900 | (05) | FL |
20237 | BLUE CROSS BLUE SHIELD (01) | FL |
4418042 | AETNA PROVIDER # (01) | FL |
T77509 | (02) | FL |