Provider Demographics
NPI:1053456178
Name:SEILER, MARTIN R (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:R
Last Name:SEILER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 SE LOOP 338
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79762-9703
Mailing Address - Country:US
Mailing Address - Phone:432-367-5116
Mailing Address - Fax:432-550-5492
Practice Address - Street 1:155 SE LOOP 338
Practice Address - Street 2:SUITE 300
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-9703
Practice Address - Country:US
Practice Address - Phone:432-367-5116
Practice Address - Fax:432-550-5492
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX505972OtherBLUE CROSS BLUE SHIELD
TX0438430001Medicare NSC