Provider Demographics
NPI:1609926864
Name:SELLERS, MICHAEL R (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:SELLERS
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 1:7552 N LA CHOLLA BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85741-2307
Mailing Address - Country:US
Mailing Address - Phone:520-744-1711
Mailing Address - Fax:520-744-7973
Practice Address - Street 1:7552 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-2307
Practice Address - Country:US
Practice Address - Phone:520-744-1711
Practice Address - Fax:520-744-7973
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0213152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ21696OtherSPECTERA
AZ2482968OtherVISION ONE
AZ2482968OtherAETNA
AZVAZ006568OtherAVESIS
AZ001434561OtherMEDICARE SECURE HORIZONS
AZ035304Medicaid
AZT76949Medicare UPIN