Healthcare Provider Details

I. General information

NPI: 1609793520
Provider Name (Legal Business Name): AUDREY SELLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 S OLD HIGHWAY 94 STE 120
SAINT CHARLES MO
63303-3707
US

IV. Provider business mailing address

1529 S OLD HIGHWAY 94 STE 120
SAINT CHARLES MO
63303-3707
US

V. Phone/Fax

Practice location:
  • Phone: 636-949-2900
  • Fax:
Mailing address:
  • Phone: 636-949-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2026021913
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: