Provider Demographics
NPI:1821263435
Name:SELAH EYEWEAR INC.
Entity Type:Organization
Organization Name:SELAH EYEWEAR INC.
Other - Org Name:AMERICAN EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-495-0607
Mailing Address - Street 1:1275 YORK RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-7565
Mailing Address - Country:US
Mailing Address - Phone:717-334-3848
Mailing Address - Fax:717-334-0196
Practice Address - Street 1:1275 YORK RD
Practice Address - Street 2:SUITE #1
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7565
Practice Address - Country:US
Practice Address - Phone:717-334-3848
Practice Address - Fax:717-334-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000004333332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001299911-001Medicaid
203808Medicare PIN
PA6195550001Medicare NSC