Provider Demographics
NPI:1043965205
Name:JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
Entity Type:Organization
Organization Name:JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
Other - Org Name:STATE STREET OPTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-463-1139
Mailing Address - Street 1:1321 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-1242
Mailing Address - Country:US
Mailing Address - Phone:989-463-1139
Mailing Address - Fax:
Practice Address - Street 1:322 N STATE ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1635
Practice Address - Country:US
Practice Address - Phone:989-463-1139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAMES H SEALS PETER B TACIA & TAD J BARTZ OD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-16
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty