Provider Demographics
NPI:1043372550
Name:SELLER EYE CLINIC, PA
Entity Type:Organization
Organization Name:SELLER EYE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:SELLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:501-321-2473
Mailing Address - Street 1:103 RIDGEWAY ST
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901
Mailing Address - Country:US
Mailing Address - Phone:501-321-2472
Mailing Address - Fax:501-321-3592
Practice Address - Street 1:103 RIDGEWAY ST
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901
Practice Address - Country:US
Practice Address - Phone:501-321-2472
Practice Address - Fax:501-321-3592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102427722Medicaid
AR102427722Medicaid
AR5791990001Medicare NSC