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General NPI Number Information
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NPI Number | 1760652473
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Entity Type | Organization
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Legal Business Name | DR ROBERT M SELBERT FAMILY EYE CARE CENTER
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 93 GUY PARK AVE
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City | AMSTERDAM
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State | NY
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Zip | 12010
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Country | US
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Telephone | 518-842-9676
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Fax | 518-842-0120
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Provider Business Mailing Address
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Address Line | 93 GUY PARK AVE
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City | AMSTERDAM
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State | NY
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Zip | 12010
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Country | US
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Telephone | 518-842-9676
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Fax | 518-842-0120
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT MELVIN SELBERT
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Credential | OD
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Telephone | 518-842-9676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | TUV0025991
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License Number State | NY
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