Provider Demographics
NPI:1003113606
Name:SALLEY, SETH AARON (OD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:AARON
Last Name:SALLEY
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 1:618 OAKLEAF OFFICE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-4820
Mailing Address - Country:US
Mailing Address - Phone:901-821-8337
Mailing Address - Fax:901-379-8297
Practice Address - Street 1:618 OAKLEAF OFFICE LN STE 100
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-4820
Practice Address - Country:US
Practice Address - Phone:901-821-8337
Practice Address - Fax:901-379-8297
Is Sole Proprietor?:No
Enumeration Date:2011-02-16
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0D0000002943152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ010698Medicaid
MS04989221Medicaid