Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3508 | MN |
NPI | 1003345067 |
---|---|
Provider Name | Dr. Spencer Seibert |
First Address | Fairmont, MN 56031-1850 |
Second Address | Fairmont, MN 56031-1850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2017 |
Last Update Date | 17/03/2018 |