Healthcare Provider Details

I. General information

NPI: 1013899004
Provider Name (Legal Business Name): SELENA ZHAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 CENTRAL AVE
LYNN MA
01901-1201
US

IV. Provider business mailing address

6106 SE 90TH AVE
PORTLAND OR
97266-5204
US

V. Phone/Fax

Practice location:
  • Phone: 781-595-1350
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD.OD.70149969
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: