Healthcare Provider Details

I. General information

NPI: 1770576696
Provider Name (Legal Business Name): JOHN CHRISTIAN SELLECHIO O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2374 POST RD SUITE 104
WARWICK RI
02886-2270
US

IV. Provider business mailing address

2374 POST RD SUITE 104
WARWICK RI
02886-2270
US

V. Phone/Fax

Practice location:
  • Phone: 401-921-0098
  • Fax: 401-921-7300
Mailing address:
  • Phone: 401-921-0098
  • Fax: 401-921-7300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODTG00512
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: