Provider Demographics
NPI:1467667717
Name:BARKSDALE, SELENA JANICE (OD)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:JANICE
Last Name:BARKSDALE
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 1:6 GRANADA CRES APT 10
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1221
Mailing Address - Country:US
Mailing Address - Phone:914-761-2456
Mailing Address - Fax:
Practice Address - Street 1:6 GRANADA CRES APT 10
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-1221
Practice Address - Country:US
Practice Address - Phone:914-761-2456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004359-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU30543Medicare ID - Type Unspecified
NY5410PKMedicare PIN