MEDICARE: SELINA ABUNDEZ

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	156FX1800X	Optician	LDO003127	GA

General Provider Information

NPI Number	:	1871439141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SELINA ABUNDEZ

Provider Business Mailing Address
First Line	:	2571 CREEKVIEW DR SW
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30008-5008
Country	:	US
Telephone Number	:	678-887-1486
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 COBB PKWY S
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-6509
Country	:	US
Telephone Number	:	770-429-9096
Fax Number	:

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

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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Directions to “ SELINA ABUNDEZ ” Practice Location

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