Provider Demographics
NPI:1073708152
Name:SELDON, AUDRA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:AUDRA
Middle Name:LYNN
Last Name:SELDON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-4902
Mailing Address - Country:US
Mailing Address - Phone:401-523-6060
Mailing Address - Fax:
Practice Address - Street 1:43 SMITH AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02841
Practice Address - Country:US
Practice Address - Phone:401-841-6717
Practice Address - Fax:401-841-6709
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist