Individual
DR. COSMO SALIBELLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
23500 NE SANDY BLVD, LOCATED INSIDE WALMART, WOOD VILLAGE, OR 97060-9653
(503) 667-8869
(503) 667-7598
Mailing address
9898 SW LYNWOOD TER, PORTLAND, OR 97225-4341
(503) 296-7655
(503) 296-7655
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1658 ATI
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212994
HEALTH NET ID NUMBER
OR
05
—
214056
—
OR
Enumeration date
09/17/2006
Last updated
07/09/2007
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