Provider Demographics
NPI:1558439588
Name:SELARIO, JAMES A (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:SELARIO
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 1:126 S CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-2804
Mailing Address - Country:US
Mailing Address - Phone:304-622-7172
Mailing Address - Fax:304-622-5380
Practice Address - Street 1:126 S CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-2804
Practice Address - Country:US
Practice Address - Phone:304-622-7172
Practice Address - Fax:304-622-5380
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV644-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149314000Medicaid
WVSE9156942Medicare ID - Type Unspecified
WVT32537Medicare UPIN
WV0367340001Medicare NSC