MEDICARE: MRS. SIMONA PAULA SELEGEAN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6121T	TX

General Provider Information

NPI Number	:	1649493321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SIMONA PAULA SELEGEAN O.D.

Provider Business Mailing Address
First Line	:	1535 TELKWA DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-2683
Country	:	US
Telephone Number	:	432-368-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 E 42ND ST
Second Line	:	BOX 12
City	:	ODESSA
State	:	TX
Zip	:	79762-7239
Country	:	US
Telephone Number	:	432-367-8308
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	07/08/2007

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