Provider Demographics
NPI:1629708904
Name:SELLEW, WILLIAM JORDAN (LDO,ABO,NCLE)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JORDAN
Last Name:SELLEW
Suffix:
Gender:M
Credentials:LDO,ABO,NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 BYPASS 72 NW
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29649-1300
Mailing Address - Country:US
Mailing Address - Phone:864-229-8008
Mailing Address - Fax:864-229-6716
Practice Address - Street 1:508 BYPASS 72 NW
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29649-1300
Practice Address - Country:US
Practice Address - Phone:864-229-8008
Practice Address - Fax:864-229-6716
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC890156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician