Individual provider Active NPI

James A. Selario, O.D.

  • Optometrist
  • Clarksburg, WV
National Provider Identifier
1558439588
Registry record updated Sep 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
644-OD Issued in WV
Practice address
126 S Chestnut St
Clarksburg, WV 26301-2804
Phone
(304) 622-7172
Fax
(304) 622-5380
NPI assigned
Nov 30, 2006
Last updated
Sep 3, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 3, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 644-OD WV Primary

Addresses

Primary practice location

126 S Chestnut St
Clarksburg, WV 26301-2804

Mailing address

126 S Chestnut St
Clarksburg, WV 26301-2804
Phone (304) 622-7172

Other identifiers 1

IdentifierTypeStateIssuer
0149314000MedicaidWV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101117001253 WV Practitioner - Optometry 5890808265 Practice locations: Clarksburg, WV

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283472000000",
    "number": "1558439588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 S CHESTNUT ST",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263012804",
            "telephone_number": "304-622-7172",
            "fax_number": "304-622-5380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 S CHESTNUT ST",
            "city": "CLARKSBURG",
            "state": "WV",
            "postal_code": "263012804",
            "telephone_number": "304-622-7172",
            "fax_number": "304-622-5380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SELARIO",
        "first_name": "JAMES",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2010-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "644-OD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0149314000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksburg, WV

Sources for this page

Verify at the official NPI Registry.