Provider Demographics
NPI:1841382074
Name:SELANDER, ERIC MARSHAL (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:MARSHAL
Last Name:SELANDER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3608 OOLTEWAH RINGGOLD RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-8045
Mailing Address - Country:US
Mailing Address - Phone:423-745-5100
Mailing Address - Fax:423-745-1577
Practice Address - Street 1:1815 DECATUR PIKE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-4932
Practice Address - Country:US
Practice Address - Phone:423-745-5100
Practice Address - Fax:423-745-1577
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD-T2529152W00000X
NE1141152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3946442Medicaid
TN4103696OtherBCBS OF TN
TN27756OtherSPECTERA
TN34569OtherAVESIS
TN6446864OtherCIGNA
TN52645OtherDAVIS VISION
TN442201OtherNATIONAL VISION ADMINISTR
P00279700OtherRAILROAD MEDICARE
TN442201OtherNATIONAL VISION ADMINISTR
TN52645OtherDAVIS VISION