Provider Demographics
NPI:1770576696
Name:SELLECHIO, JOHN CHRISTIAN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTIAN
Last Name:SELLECHIO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2374 POST RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2270
Mailing Address - Country:US
Mailing Address - Phone:401-921-0098
Mailing Address - Fax:401-921-7300
Practice Address - Street 1:2374 POST RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2270
Practice Address - Country:US
Practice Address - Phone:401-921-0098
Practice Address - Fax:401-921-7300
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00512152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI201964382OtherUNITED HEALTHCARE
RI294180OtherBLUE CROSS BLUE SHIELD
RIJS72803Medicaid
RI410486OtherBLUE CHIP
RI709006298Medicare PIN
RI410486OtherBLUE CHIP