| Organization Name: | PRIME OPTICAL |
| NPI Number: | 1609247279 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIANO SALCEDO (OWNER/OPTICIAN) |
| Mailing Address: | 407 E Gilbert St Suite # 10 San Bernardino |
| State: | CA US |
| Postal Code: | 924045325 |
| Phone Number: | 9098888700 |
| Fax Number: | 9098888710 |
| NPI Enumeration Date: | 10/08/2015 |
| NPI Last Update Date: | 10/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332H00000X |
| License Number: | SL40434 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Eyewear Supplier (Equipment, not the service) |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |