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General NPI Number Information
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NPI Number | 1649493321
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Entity Type | Individual
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Provider Name | SIMONA PAULA SELEGEAN O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4101 E 42ND ST BOX 12
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City | ODESSA
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State | TX
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Zip | 79762-7239
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Country | US
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Telephone | 432-367-8308
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Fax |
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Provider Business Mailing Address
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Address Line | 1535 TELKWA DR
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City | SPRING
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State | TX
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Zip | 77386-2683
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Country | US
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Telephone | 432-368-9036
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6121T
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License Number State | TX
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