Provider Demographics
NPI:1538162847
Name:SALVAS, MARIE KATHLEEN (OD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:KATHLEEN
Last Name:SALVAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 LAKEVIEW AVE
Mailing Address - Street 2:STE 4
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4762
Mailing Address - Country:US
Mailing Address - Phone:978-957-5665
Mailing Address - Fax:
Practice Address - Street 1:1105 LAKEVIEW AVE
Practice Address - Street 2:STE 4
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826-4762
Practice Address - Country:US
Practice Address - Phone:978-957-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3081152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
220558Medicare PIN
0128140001Medicare NSC
MAT59368Medicare UPIN