Organization
PRIME OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARIANO SALCEDO RDO (OWNER/OPTICIAN)
(909) 888-8700
Entity
Organization
Contact information
Practice address
407 E GILBERT ST, SUITE # 10, SAN BERNARDINO, CA 92404-5325
(909) 888-8700
(909) 888-8710
Mailing address
407 E GILBERT ST, SUITE # 10, SAN BERNARDINO, CA 92404-5325
(909) 888-8700
(909) 888-8710
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
SL40434
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8005541312
EIN
CA
Enumeration date
10/08/2015
Last updated
10/08/2015
Update your record
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