Provider Demographics
NPI:1255318929
Name:SELBYG, JON ARNE (OD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:ARNE
Last Name:SELBYG
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 1:21200 OLHAVA WAY NW
Mailing Address - Street 2:VISION CENTER
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-9457
Mailing Address - Country:US
Mailing Address - Phone:360-697-2513
Mailing Address - Fax:
Practice Address - Street 1:21200 OLHAVA WAY NW
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-9457
Practice Address - Country:US
Practice Address - Phone:360-697-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2900-035152W00000X
WA60612986152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist