Provider Demographics
NPI:1821216474
Name:ADVANCED SIERRA EYECARE, INC.
Entity Type:Organization
Organization Name:ADVANCED SIERRA EYECARE, INC.
Other - Org Name:DR. BENJAMIN C. SELJESTAD
Other - Org Type:Other Name
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:SELJESTAD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-884-2020
Mailing Address - Street 1:3450 CONTE DR
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89701-4896
Mailing Address - Country:US
Mailing Address - Phone:775-884-2020
Mailing Address - Fax:
Practice Address - Street 1:3033 N CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-0153
Practice Address - Country:US
Practice Address - Phone:775-884-2020
Practice Address - Fax:775-234-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV13805OtherSPECTERA
NV7944377OtherAETNA
NV13805OtherSPECTERA
NV7944377OtherAETNA
NVV39992Medicare ID - Type UnspecifiedINDIVIDUAL WITHIN GROUP