Provider Demographics
NPI:1396913364
Name:DR RAYMOND J SEELEY
Entity type:Organization
Organization Name:DR RAYMOND J SEELEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:570-297-3192
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:547 CANTON ST
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1404
Mailing Address - Country:US
Mailing Address - Phone:570-297-3192
Mailing Address - Fax:570-297-4778
Practice Address - Street 1:547 CANTON ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1404
Practice Address - Country:US
Practice Address - Phone:570-297-3192
Practice Address - Fax:570-297-4778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000042332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0283210001Medicare NSC