Provider Demographics
NPI:1902077977
Name:DR TIM SELLERS, OPTOMETRIST
Entity Type:Organization
Organization Name:DR TIM SELLERS, OPTOMETRIST
Other - Org Name:FAMILY VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:M
Authorized Official - Last Name:SELLERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-896-4596
Mailing Address - Street 1:500 N PARRISH AVE
Mailing Address - Street 2:
Mailing Address - City:ADEL
Mailing Address - State:GA
Mailing Address - Zip Code:31620-2036
Mailing Address - Country:US
Mailing Address - Phone:229-896-4596
Mailing Address - Fax:229-896-5437
Practice Address - Street 1:500 N PARRISH AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-2036
Practice Address - Country:US
Practice Address - Phone:229-896-4596
Practice Address - Fax:229-896-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3926840001332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA3926840001Medicare NSC