Provider Demographics
NPI:1649493321
Name:SELEGEAN, SIMONA PAULA (OD)
Entity type:Individual
Prefix:MRS
First Name:SIMONA
Middle Name:PAULA
Last Name:SELEGEAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1535 TELKWA DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2683
Mailing Address - Country:US
Mailing Address - Phone:432-368-9036
Mailing Address - Fax:
Practice Address - Street 1:4101 E 42ND ST
Practice Address - Street 2:BOX 12
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-7239
Practice Address - Country:US
Practice Address - Phone:432-367-8308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6121T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist