Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1053456178 |
---|---|
Provider Name | Mr. Martin R Seiler |
First Address | Odessa, TX 79762-9703 |
Second Address | Odessa, TX 79762-9703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 28/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
505972 | BLUE CROSS BLUE SHIELD (01) | TX |