Provider Demographics
NPI:1366474413
Name:SALMAN, JEFFREY DEAN (OD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DEAN
Last Name:SALMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2697
Mailing Address - Country:US
Mailing Address - Phone:415-457-2020
Mailing Address - Fax:415-457-2047
Practice Address - Street 1:1924 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2697
Practice Address - Country:US
Practice Address - Phone:415-457-2020
Practice Address - Fax:415-457-2047
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9594T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGU762AMedicare PIN