Provider Demographics
NPI:1902850647
Name:SELLON, ROSHANI PATEL (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSHANI
Middle Name:PATEL
Last Name:SELLON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ROSHANI
Other - Middle Name:G
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:25 25TH ST SE
Mailing Address - Street 2:WAL-MART SOUTH VISION CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55904-5554
Mailing Address - Country:US
Mailing Address - Phone:507-292-1729
Mailing Address - Fax:507-292-1731
Practice Address - Street 1:25 25TH ST SE
Practice Address - Street 2:WAL-MART SOUTH VISION CENTER
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5554
Practice Address - Country:US
Practice Address - Phone:507-292-1729
Practice Address - Fax:507-292-1731
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3136152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIVAD000Medicare UPIN