Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 0D0000002943 | TN |
NPI | 1003113606 |
---|---|
Provider Name | Mr. Seth Aaron Salley |
First Address | Memphis, TN 38120-9411 |
Second Address | Memphis, TN 38120-9411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 15/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04989221 | (05) | MS |
Q010698 | (05) | TN |