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General NPI Number Information
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NPI Number | 1841382074
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Entity Type | Individual
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Provider Name | ERIC MARSHAL SELANDER O.D.
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Gender | Male
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Dates
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Enumeration Date | 09/28/2006
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Last Update Date | 06/11/2011
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Provider Practice Location Address
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Address Line | 1815 DECATUR PIKE
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City | ATHENS
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State | TN
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Zip | 37303-4932
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Country | US
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Telephone | 423-745-5100
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Fax | 423-745-1577
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Provider Business Mailing Address
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Address Line | 3608 OOLTEWAH RINGGOLD RD
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City | OOLTEWAH
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State | TN
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Zip | 37363-8045
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Country | US
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Telephone | 423-745-5100
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Fax | 423-745-1577
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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 | OD-T2529
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1141
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License Number State | NE
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