Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 112925-9934 | UT |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 112925-9934 | UT |
NPI | 1326196569 |
---|---|
Provider Name | Dr. Jeff H Seeholzer |
First Address | Logan, UT 84321-4526 |
Second Address | Logan, UT 84321-4526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2007 |
Last Update Date | 10/12/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0523110001 | MEDICARE DME (01) | UT |