Provider Demographics
NPI:1336134378
Name:SEELEY, RAYMOND JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:JOSEPH
Last Name:SEELEY
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 1:172 CANTON ST
Mailing Address - Street 2:PO BOX 219
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1404
Mailing Address - Country:US
Mailing Address - Phone:570-297-3192
Mailing Address - Fax:
Practice Address - Street 1:172 CANTON ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1404
Practice Address - Country:US
Practice Address - Phone:570-297-3192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000042152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U10066Medicare UPIN
PASE288473Medicare ID - Type Unspecified