Healthcare Provider Details

I. General information

NPI: 1194778126
Provider Name (Legal Business Name): RICHARD E SELSER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/19/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 S TRIMBLE RD
MANSFIELD OH
44906-3416
US

IV. Provider business mailing address

466 S TRIMBLE RD
MANSFIELD OH
44906-3416
US

V. Phone/Fax

Practice location:
  • Phone: 419-756-8000
  • Fax: 419-756-7100
Mailing address:
  • Phone: 419-756-8000
  • Fax: 419-756-7100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35088308
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: