Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 046.010192 | IL |
Y | 152W00000X | Optometrist | 2842 | TN |
NPI | 1013164672 |
---|---|
Provider Name | Dr. Susan Andrea Seabold |
First Address | Freeport, IL 61032-9370 |
Second Address | Freeport, IL 61032-9370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2008 |
Last Update Date | 07/05/2009 |