Provider Demographics
NPI:1033778014
Name:SEITZ, CORY (OD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:
Last Name:SEITZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 S RED FILLY RD
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1332
Mailing Address - Country:US
Mailing Address - Phone:435-219-0033
Mailing Address - Fax:
Practice Address - Street 1:37 E 100 N
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1700
Practice Address - Country:US
Practice Address - Phone:435-654-1863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11325020-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist