Provider Demographics
NPI:1407026412
Name:JAMES C. SELPH, O.D.
Entity Type:Organization
Organization Name:JAMES C. SELPH, O.D.
Other - Org Name:LAKEHURST EYE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:SELPH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-657-0440
Mailing Address - Street 1:29 UNION AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:08733-3023
Mailing Address - Country:US
Mailing Address - Phone:732-657-0440
Mailing Address - Fax:732-657-4240
Practice Address - Street 1:29 UNION AVE
Practice Address - Street 2:
Practice Address - City:LAKEHURST
Practice Address - State:NJ
Practice Address - Zip Code:08733-3023
Practice Address - Country:US
Practice Address - Phone:732-657-0440
Practice Address - Fax:732-657-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00448700332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0246980001Medicare NSC
521549Medicare PIN
U26909Medicare UPIN