Provider Demographics
NPI:1689851396
Name:SELDEN EYECARE, LLC
Entity Type:Organization
Organization Name:SELDEN EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:724-543-4293
Mailing Address - Street 1:11931 STATE ROUTE 85
Mailing Address - Street 2:SUITE F
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201
Mailing Address - Country:US
Mailing Address - Phone:724-543-4293
Mailing Address - Fax:724-543-0228
Practice Address - Street 1:11931 STATE ROUTE 85
Practice Address - Street 2:SUITE F
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201
Practice Address - Country:US
Practice Address - Phone:724-543-4293
Practice Address - Fax:724-543-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-24
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001454152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU04493Medicare UPIN
PASE626387Medicare PIN