Provider Demographics
NPI:1174743868
Name:PETERSON-SALGADO, KRISTIN MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIE
Last Name:PETERSON-SALGADO
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 1:977 LOMAS SANTA FE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2138
Mailing Address - Country:US
Mailing Address - Phone:858-259-8239
Mailing Address - Fax:858-259-8317
Practice Address - Street 1:977 LOMAS SANTA FE DR
Practice Address - Street 2:SUITE B
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2138
Practice Address - Country:US
Practice Address - Phone:858-259-8239
Practice Address - Fax:858-259-8317
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 10955 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist